Dáil Éireann debate -
Tuesday, 1 Jun 1976

Vol. 291 No. 4

Vote 50: Health (Resumed).

Debate resumed on the following motion:

That a sum not exceeding £249,983,000 be granted to defray the charge which will come in course of payment during the year ending the 31st day of December, 1976, 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.)

Mr. Brosnan

I was hoping that the Minister for Health would be present but unfortunately he is not, once again. Last Thursday I made a personal appeal to the Minister about a matter relating to County Cork and on that occasion I expressed my regret that neither he nor his Parliamentary Secretary were present. The matter about which I am concerned is a complicated one and I shall address myself to the Minister for Agriculture and Fisheries who is present in the hope that he will convey my sentiments to his colleague.

When the Health Act, 1970, came into force the Health Advisory Committee to the Southern Committee of Cork County Council was abolished despite many requests, appeals and demands by myself and all of my colleagues irrespective of their political persuasion. All of us appealed to the then Minister for Health, the late Mr. Childers, and to the present Minister, on very many occasions to have this body reconstituted but our efforts were to no avail. The appeals were made by way of deputation, by resolution to the Cork County Council and by way of resolution from the Southern Committee. I also raised the matter in the House in parliamentary questions and I took up the matter with the Minister and his Parliamentary Secretary, whom I am glad to see is now present.

The Parliamentary Secretary was party to what was probably the first appeal to the Minister's predecessor requesting him to have the advisory health committee reconstituted and reinstated but all the appeals fell on deaf ears. I am now repeating my appeal once again and I trust the Parliamentary Secretary will convey my sentiments, which I am sure are shared by him, to the Minister and that he will at last accede to this request on the part of public representatives from that part of County Cork. I might add that the Minister's predecessor was adamant in his refusal. One of the reasons he gave for not reinstating this body was that, in conjunction with members of the Cork Corporation, the committee would be too large and unwieldy. I would point out to the House, and particularly to the Parliamentary Secretary, that I and my colleagues in the southern health area feel very strongly about this matter. If the Minister fully examines the position he will appreciate the enormity of the injustice being done not only to the public representatives in question but also to the people whom they represent.

The effect of the decision is that both the public representatives and the people are completely disenfranchised and have no say, good, bad or indifferent in health matters. The Minister and his Parliamentary Secretary in former years were public representatives at a lower level and they know that health matters constitute the greater and most important part of the work and responsibilities of a public representatives, whether he is a Member of either House of the Oireachtas or is a member of a county council. Public representatives have to deal with matters such as admissions to hospitals, medical cards and hospital bills. Unlike matters such as housing, water and sewerage schemes health problems keep recurring. When a housing or sewerage scheme is completed that is usually the end of the matter but health problems multiply over the years. Such problems will always be with us and for that reason it is inequitable—in fact, iniquitous— that the representatives on the southern committee of the Cork County Council should be cut off and have no say whatever.

I should like to state that the area served by that committee is the most populous and progressive area outside Dublin. It covers six large towns— Cobh, Youghal and Midleton, on the east side, and Bandon, Kinsale and Macroom on the west side. There is a hospital in each of those towns. It is wrong that the representatives of that area should have as much say in the running of those hospitals as the Leas-Cheann Comhairle. We have no access to the officials who administer those hospitals. In addition, bordering on this area there is the mental hospital on the Lee Road and the auxiliary mental hospital in Youghal. Just outside the southern area there is one of the biggest hospitals in the south at Sarsfield Court. It is a complete denial and a travesty of democracy that representatives for that area have no say in the running of those hospitals.

There is a sizeable industry in all the towns I have mentioned and it is expected that this area will become more important in the future. If there is to be any major development in any part of the country in the next few years it will be in that area. I should also like to mention that there is no public representatives from the Midleton electoral area on the Southern Health Board. We are completely cut off. I appeal to the Minister, on behalf of the people of that area, to reconstitute an advisory health committee for that area. At present we do not know the officials who deal with health matters for the area. Those officials ignore us when we make requests to them because they know we have no comeback. They can afford to ignore us. I am sure that when the Minister realises the grave injustice that is being done to the people of that area he will reconstitute that health board.

On Thursday last I appealed for the provision of an ambulance for Cobh and I wish to repeat that today. I have made repeated demands for such an ambulance to the Minister and the Southern Health Board, but those demands have fallen on deaf ears. The excellent case made by a deputation who met the Minister was also ignored. Cobh is an isolated town and is cut off. It is not easy of access and it is easy for a strange driver to get lost in the district. That occurred recently when the ambulance driver from Midleton spent half an hour looking for directions.

The Minister, when dealing with the question of excessive drinking, dismissed it with a couple of words saying that the campaign against excessive drinking was being continued. I am sure the Minister knows that excessive drinking and alcoholism represents probably the greatest single evil we have. It is primarily a matter for the Minister and his advisers to face this problem, but they have not done so. It is not so much the excessive drinking as the attendant evils which flow from it: the spin-off evils are very numerous, assaults, robberies, sexual crimes of all kinds. You can attribute practically 90 per cent of all crime, I submit, directly or indirectly to excessive drinking. Therefore, I appeal to the Minister to face up to this problem in a serious and realistic manner. I also appeal to him to consider seriously my requests regarding the advisory health committees and to rectify a situation which is inequitable and completely wrong.

Mr. Carter

This debate has been going on for some time and many aspects of health have already been dealt with. The Minister's brief was very comprehensive and his statistics informative. Whatever shortage of money there may be in the Department nobody can deny that the Minister has a compassionate mind. Those with the best interests of the health service at heart, regardless of the side of the House to which they belong would not deny the compliment to the Minister that he has high motives. There are aspects of the Department's work which I could criticise, I suppose any other Deputy could, but I hope in doing that also to express some constructive ideas.

The other night I looked through the report of the Irish Hospitals Trust and also, in a very cursory manner through Dr. Hensey's very informative book on the health system. I was very edified in glancing through the Irish Hospitals Trust booklet to see the progress we had made by means of funds provided by Irish Hospitals Trust since its foundation. When it comes to discussing health there is not sufficient reference to this side of the subject because, without doubt, a large number of our voluntary hospitals would already be closed if they were solely dependent on patients' fees and on the State. Funds provided by the Irish Hospitals Trust have been the means of keeping hospitalisation to the fore. We are always highly critical of our hospitals, sometimes of the staff and sometimes of the manpower in health, but we are not always so ready to extend to those who work in hospitals the praise I believe is rightly due to them.

The total Vote for Health is roughly £250 million which is an enormous amount of money when one considers that even at the present time a person who controls £1 million is known as a millionaire. This should bring home to people the colossal expenditure on health. I suppose this is the case because health is a very large employer of manpower. It is a labour intensive organisation and when labour costs increase even slightly this is reflected in increased health expenditure. As politicians we differ in our approach on the methods of providing those moneys. The first time the Minister said that he hoped to be able, at some stage, to provide a free health service I said that he would never be able to do it, that we would not be able to raise the necessary finance. I shall return to this subject when I refer later to a scheme recently proposed by the medical profession for a health insurance scheme. We have a voluntary health insurance scheme but they have come up with the idea of a compulsory scheme to which I shall return later.

Reviewing the health system in general from the Famine onwards, one can see the terrible problems encountered and, bad as the poor law system which brought us up to the beginning of this century was, it had certain good features. Like the curate's egg, it had good and bad spots. I want to make the point that the Irish Hospitals Trust have provided £109 million towards hospital improvement since its foundation in the thirties towards the betterment of hospitals. That is an enormous investment and an enormous amount of money, and I think it made us hospital-minded and brought us up to the stage when led by the Department of Health, we could consider the betterment of our hospital system in general.

I do not want to name the institutions in Dublin which improved standards by means of funds from the Irish Hospitals Trust, but there is hardly a hospital in Dublin or outside that did not share the allocation of those funds. Some of our hospitals, the very oldest of them which we have preserved, shall we say, today present a very pleasing picture, not merely from the medical end but also from the architectural point of view. Admittedly some of them could be vastly improved by the investment of more funds, more medical appliances and so on. However, is it not grand to be able to say that we have hospitals which were built in the 17th century and which are going strong today? I pose the question to this House that, but for this constant income down the years, where would some of our leading hospitals be today?

Regarding this total of £109 million, this was raised not merely in relation to hospitals but in relation to foreign earnings by the Irish Hospitals Trust and by the activities of the Irish Hospitals Trust from an employer's point of view. I want to refer to this very pointedly in relation to foreign earnings. The Irish Hospitals Trust is a large employer of labour and to this extent provides a very useful service to the community. Those are a few points which, even at this late stage, should be made in recognition of the work done down the years by the Irish Hospitals Trust.

I come to other matters related to health and I want to deal very briefly with an argument which is going on in my own constituency in regard to hospitalisation. As I said, long before we were able as an organisation, either local or central, to provide sufficient funds for capital development in hospitals we had this aid by moneys raised by the Irish Hospitals Trust which led us on to the stage about 1968 when the book known as the brown book on hospitalisation was published. As those of us who acted on the Select Committee on Health in the early 1960s are aware—and I think the Minister for Health was one of the personnel of that committee then— most of the recommendations made by the FitzGerald Council, or Committee as it was called at that time, sprang from the ramifications of that Select Committee on Health which was assembled away back in the early 1960s. Regrettably the report of that committee was never published or laid before the House, nor were the public ever made aware fully of the content of the report of that committee. I would say in all there were over 60 meetings of it held and I attended nearly all of the 60. I improved considerably my education regarding medical matters, and I was hopeful at that time that something very special would emerge from that all-party committee. Nothing emerged at that stage, but in 1968 the FitzGerald Committee presented this report, a report by 18 doctors, some of them surgeons, more of them physicians, some of them on a county basis, more on a regional basis and from voluntary hospitals. The committee was chaired by Doctor Patrick FitzGerald, at that time head surgeon at St. Vincent's Hospital. The report proposed, and I think rightly so in view of the fact that county boundaries were no longer able to contain units which would serve the higher interest of medicine, especially from a surgical point of view, that the hospitals of the future should be constructed on a regional basis, and I think at that stage it set out the concentration of 12 areas for hospitalisation. That was all very well. The report was accepted by the Government. Regrettably, in the interval the moneys necessary for investment in large-scale hospitalisation were not readily available.

At any rate I come to the point where the present Tánaiste and Minister for Health asked Comhairle na n-Ospidéal to consider some amendment of the FitzGerald Report on the grounds that some parts of it, while logical, might not be easily accomplished from a practical point of view. He therefore asked the Comhairle to set out guidelines for the regions, which were disagreed, mainly on the locations or the proposed locations of some of those hospitals. At any rate, in regard to the Midland Health Board the Minister published his report on 21st October, 1975, and he called it the general hospital development plan. In that he set out very briefly certain ideas which would suit the Midland Health Board when it came to hospitalisation. The House will be aware that we have had various arguments, even on the floor of this House, regarding the provision of hospitalisation for the county of Longford and we had what developed into an argument here between a former Minister for Health and myself on this issue. Longford County could not afford a modern scale hospital. The county boundaries are too small and the money necessary to build such a unit would not be easily forthcoming. Therefore, we have always looked to our neighbouring county, Westmeath and the hospital located in Mullingar as a means of providing a surgical service for the County of Longford. Towards that end the Midland Health Board set up a working party to consider the Minister's proposal. The Minister's proposal was that instead of one large scale hospital we have at least two. The large scale hospital thought of at the time was one in Tullamore which was mentioned only in passing in the FitzGerald Report. In the nature of things, Mullingar entered the picture as a large county hospital and the only surgical one on the road between Sligo and Dublin. At the other end of the scale Portlaoise came into the picture as being the largest hospital providing surgery facilities between Limerick and Dublin.

The Midlands Health Board held a series of meetings on the matter, studied the Minister's plan and the plan put forward by their own representatives. In that context the health board came up with the idea of upgrading the hospitals in Mullingar and Portlaoise. The conditions laid down then were that there would be two minimum scale surgical hospitals in each of those areas. It was visualised that Mullingar Hospital, if upgraded and extended, should be able to provide the necessary beds for Longford.

That was a scheme of which our county health committee approved as did also the committees for Westmeath and Laois. At a meeting of the Midland Health Board previous plans were rescinded and the new plan adopted by a three-to-one vote. That was done on the grounds of it being in the best interests of the patients. The old plan provided that no patient should be more than sixty miles from a fairly large hospital. The new plan provided that no patient be further than 30 miles from a reasonably good hospital and the board, on the advice of its committees, so decided.

It is now being contended by certain people who write to local newspapers that there is some rethinking taking place in respect of this matter, not at ministerial level, but that certain politicians are alleged to have said that there should be one hospital only in the area and that that should be located in Tullamore. I want to say straightaway on the floor of this House, that I do not see any Minister rescinding a decision arrived at by a health board, representing approximately 100,000 people spread over the midlands, on the advice of its representatives from every corner of that region. I do not see any Minister for Health putting any pressure on any health board to rescind a motion of that kind, be he past, present or future. That is a decision arrived at in a purely democratic fashion, based on the best possible demographic and medical opinion and designed to cater for the highest interests in medicine, which is what we are after.

Therefore, I would say to those people engaged in trying to promote a controversy between the various interests in the Midlands to stop writing to newspapers but rather to inform themselves fully of the facts and progress from there. Health cannot always be made a political football. It should not be a political football. We, as representatives in this House, should be careful, whether at local or central level, not to make a political football of health. Health is too precious to the community to be brought down to that level—that it be kicked around and that people, by abusing one another, hope to gain something from it. I am sure that everybody in the Midlands who has the best interests not merely of surgery but all other medical matters at heart would agree with the decision of the health board. That does not mean that there should be downgrading of any hospital but rather an upgrading. Were the hospitals mentioned in a position to cater for the requisite number of patients, we would be progressing fairly well.

I was reading the Medical Times some time ago. My reading is somewhat sketchy, but, at any rate, I noticed a tendency on behalf of general practitioners to send nearly all of their maternity patients to hospitals rather than nursing homes. I wondered about this matter and I asked one or two doctors who came up with the old chestnut that the patient is much safer in a hospital. I do not contend that point but I am contending that hospital beds are scarce and dear. Perhaps I might ask the Minister why this sudden change in the system because I think it is a sudden change. Early on we were asked to subscribe to the view that the service should provide first-class maternity homes and, to that end, various communities of nuns and others invested heavily in nursing homes to find now that their capacity is not being taken up. At the same time, in the course of the last six or seven months, I have come across patients awaiting elective surgery for anything up to eleven months because they could not get beds. The administration seems to be somewhat out of joint or, perhaps, there is abuse at some level.

I read in the British Medical Journal in 1970 about a doctor aged 85 years who got the blue ribband of the year in England. He was interviewed on the BBC and was asked to explain why he qualified for the blue ribband. He was a very humble man and was very learned. He said he lived in one of the shires and that he knew all his patients. He also said: “I knew their fathers and mothers and in a good deal of cases their grandfathers and grandmothers.” He also told his interviewer: “I may not, in that case, have needed as much pathology as other medical practitioners.”

Are some of the doctors inclined to get away from their patients instead of getting near them? We believe that a doctor should follow his patient through the nursing home and if consultation is required it is available. Why have we now the switch to hospitalisation when beds are scarce? I will not delay long on this because I am not as well informed as I would like to be. That is the reason I ask: why have we under-utilisation of capacity in nursing homes? The people in charge of those homes have invested heavily to provide a very necessary service not merely to one section of the community but to humanity as well. It is a pity, when we have overloading in hospitals, that we have under-utilisation of nursing homes.

We have much less money this year for medical research. Everybody knows that, no matter how much money is provided, we will never be able to provide enough. However, when we have inflation it is a pity that we should have to have less money available for research. We are not like other countries because we have not any great share of private wealth to endow the various institutions engaging in research. It is a pity that we should have to trim our sails in relation to research. Medical research is a fact finding service in the interest of humanity and deserves the very highest praise and encouragement.

Eligibility for general medical services is a great bone of contention to many people. It is all very fine to say: "We will raise the level of eligibility from £2,250 to £3,000", but if we have not the organisation provided to meet a change like that there is no point in doing it. Several statements about the raising of eligibility were made in recent years. They are not getting us anywhere because there is not enough money available to provide the service we have in mind.

A great step in health in recent years is the reduction of the mortality rate especially in infant care and also the elimination of some of the more serious and more deadly killer diseases. It is regrettable, in relation to cancer, that we are not making greater in-roads towards cutting down this deadly disease. Every unfortunate patient who enters a hospital dreads this disease. I should like to pay a tribute to the agencies dealing with cancer, especially the Cancer Society and hospitals like St. Luke's and Hume Street who are doing such wonderful work which deserves very high praise from everybody.

We are heavily committed to geriatric care in all counties at the moment. There are various units in every county for the treatment of geriatrics, which can be very costly. However, when one looks at the aged and the fact that we are living longer one must also realise that people become geriatrics at an earlier age than 15 or 20 years ago due to the higher standards of living, less activity and so forth. The rate of progress in caring for the aged at home and in institutions is good. I want to pay a special tribute to religious organisations, whether they be Sisters of Mercy, Sisters of Charity, French Sisters of Charity, or from whatever order they come. Were it not for the investment which those religious organisations put into health we would not be able to do half the work we do in regard to care of the aged. Many of those Sisters who entered the nursing profession put back into the service a great deal more than their salaries in looking after the older people in the community.

Similarly, we have made good progress in preventive medicine. The levels of social welfare are losing the race with inflation. The aim of social welfare was to provide care for those who needed it. That is being done now. It is admitted at local level that there is no one in the country in need of either food or shelter. It is also admitted that in some cases some of these services are abused. In the nature of things that is bound to happen.

The more we do for preventive medicine the better. This will save money in other directions, for example if we can keep people who are mobile in their own homes. It is easier for them to be comfortable at home than in an institution.

Regrettably there are too many such people in institutions but that springs from another problem which I will not go into here. Due to the previous movement of people through emigration, we are left with the residue of an aging population, with more geriatrics and with more people to cater for. If the health bill is heavy in that regard, let us not complain but try to shoulder it. In good or bad times, we should try to help those people in a practical way.

Earlier I referred very briefly to the cost of providing and servicing medicine. This brings us back to the old chestnut, whether we will ever be able to provide a completely free health service for all people. I do not think we will ever reach that stage, which is a pity. It is bad enough to be sick, but it is twice as bad to have to start worrying about what you will be charged for the service and what you will have to pay to get well. This brings us to the burning question of what would be the best plan. Will it be an insurance plan, part State and part insurance, or a voluntary plan, and so on?

The voluntary health scheme works very well here. Anybody who knows anything about health knows this to be true. The voluntary health organisation have been run at a very low cost. All the contributions have gone to the betterment of the patient who needs treatment. In this way, we have come to recognise that there is something very genuine in a voluntary effort. You do not have to drive people there; they go themselves. They go in whatever direction suits them. They will invest in voluntary health if they think they will be adequately covered. The numbers in voluntary health, although, regrettably, not high in relation to our total population, indicate that that organisation is providing a good service.

I did not have time to study the plan the doctors put to the Minister for health coverage. They had in mind something along the voluntary health scheme coupled with the State spear-heading such a campaign. I wonder if that would succeed. If one looks at the British scheme one will see that, while it was a humane aim, it could very quickly wind up draining the Exchequer. It would be a praiseworthy move if the opinion of the experts in the Department of Health was sought—I have no doubt they have all the statistical information they require so that they could evaluate the doctors' plan and have it distributed to the Members of this House, members of health boards and so on. We would then see the proposals and have dialogue on them.

I have tried to convince young people starting out of the desirability of joining the vountary health scheme in case their children get sick. I am speaking now of people who are outside the scope of the general medical services scheme. I am not speaking of hospitalisation, but of the general medical services scheme. It is often said that there should be preventive medicine as well as in- or out-patient medicine. It is a boon to a family to know that if a member falls sick he will be fully covered and immunised against financial hardship.

I should like to have had more time to study the Minister's statistical information. Regrettably I did not and, therefore, must confine myself to the few matters I mentioned. The Health Vote of £250 million is enormous and 75 to 80 per cent of that amount goes on hospitalisation. This makes it more important than ever that the question of hospitalisation be restudied. If we come up with a plan we should try to put money behind the plan to make it operative. The Midland Health Board have come up with a plan for hospitalisation and I request the Minister to put the money behind the plan to make it a reality.

Mr. Kavanagh

In times of a recession the areas which are inclined to suffer from scarcity of finance are those which we are dealing with in this Estimate, that is, the extension of the health services. When it comes to paying for these services we are all inclined to the view that they can be done without for a few months or a few years. The Minister is to be complimented in that he has resisted this tendency in his Department since he has taken over. It is accepted that the recession which hit the western world, the United States and the whole of the EEC after the war in the Middle East in 1973 which resulted in the huge increase in the cost of fuel brought a great deal of problems to the extension of the budgets of all the countries in the western world, and into the continuance of the standards of living which they have become accustomed to in these areas.

The Minister's achievements in his Department during this difficult period have been very worth while. If one were to look only at the newspapers it would appear that the health services in this country were going in reverse rather than progressing very satisfactorily through that period of recession. If one were to look at it in terms of money alone, the increased expenditure during the past three years on the health services speaks for itself. The Minister has given every possible fact and figure available which anyone would require to make an assessment of the activities of his Department. In 1972 a total of £107.4 million was spent on the non-capital expenditure on health and since then this Estimate has risen to £262 million, an increase of 144 per cent in money terms. Taking into account inflation, which has dogged the western democracies in the last few years, there is still a 16 per cent increase in real terms, made possible by the Minister. This is the only real answer that one could give to critics of the Department. Extensions have taken place in many areas of the health services over the last two years. Employment in the health service in 1972-73 has increased by 4,000. This is very worth while at a time when unemployment figures have expanded. People who are sick obviously are getting a better service now because of the extra number of people working in the health service. Medical card holders have also increased substantially in the last few years. Twenty-eight per cent of the population were covered by medical cards three years ago and this figure has now increased to 36 per cent. That indicates the marked improvement that has taken place since the Minister took office.

The list of illnesses for which drugs and medicines free of charge are provided for patients has also increased. It has been extended to include Parkinson's disease, multiple sclerosis, muscular dystrophy and acute leukemia in children. These may not cover very many people but, nevertheless, for families which have a member suffering from any of these diseases this extension is of great benefit. Another important improvement is in the constant care allowance for handicapped children which was introduced at £25 a month regardless of the income of the family. A person who has a handicapped child in the family may find it a very heavy drain on his financial resources irrespective of the size of the income and, therefore this improvement is very worth while. There has also been an improvement in the disabled persons maintenance allowance and the fact that eligibility for this money has changed whereby only the income of the parents of a disabled person is taken into account is a welcome improvement and has led to an increase in the number of people getting this benefit. The number some years ago stood at about 25,000 and this has improved by about 2,000 to 3,000 in the meantime.

There are many other areas in which the Department have improved the situation and which the Minister considered suitable for improvement. Financial support has been provided for the establishment of a network of community advice centres. They are essential. The amount of legislation introduced in recent years makes it necessary that not only public representatives should be available to the public to tell them what their entitlements are. It is only fair that this should be done also by officers from the Department and trained personnel. Many people are not near enough to a TD or on principle will not go to a member of a political party who may not be of their own political persuasion, and they may be missing out on some necessary advice on health matters. That goes for other areas too. such as local government and social welfare. These community advice centres are a great step forward. I hope they will be extended as quickly as possible into areas where they are not available at present.

Training facilities for the handicapped have also been improved. The EEC Social Fund has been made use of by the Department. Claims on that fund are made continuously. Those of us who hold a dual mandate and are representatives in the European Parliament have made our demands that the Social Fund should be vastly improved so that facilities for training the handicapped can be stepped up and grants improved. In a report on the social situation in the Community for 1974 which I submitted last year, I stressed the need for a considerable extension of the Social Fund so that worth-while activities could be undertaken in Community countries. I believe a considerable improvement will be seen this year in the amount of money available in the Social Fund to finance schemes sent in not only from the Department of Health but also the Department of Social Welfare.

I thought it only fair that I should list some of the improvements in the Minister's Department. Too often we read about the things people think should be happening and which are not happening. It is useful to be positive on occasion and to remind the public what has happened over the past few years. Everybody will agree the extensions in the activities of the Department which I have mentioned and many which I have not mentioned, have been useful and worth while.

In his speech the Minister invited Members of the House to discuss the operations of the health boards. The first Bill I took any part in when I came into this House was the Bill setting up the health boards, now the 1970 Health Act. On that occasion I was critical of the areas covered by the various health boards. I considered that they were ill-devised and I maintain that opinion today. I am in the Eastern Health Board area. County Wicklow and County Kildare are an adjunct to the Dublin area and form the biggest health board area, by population if not by size. This year almost £40 million will be spent by that health board which is almost the equivalent of the Estimates introduced for certain Departments under ministerial direction.

At the time I was not satisfied that the proper balance was given on the boards to elected representatives. I am dissatisfied now with the number of elected representatives on these boards. To have only three public representatives from County Wicklow on a board of almost 40 is not enough to represent that county and its health needs. At the selection of those three representatives in Wicklow, with the connivance of the Fianna Fáil members of the council and the Sinn Féin member, Seamus Costello, the health board was deprived of representation from the Fine Gael Party and Labour Party. Well over 50 per cent of the votes cast in the county council elections were cast for those two parties. Because of the system of selection under the Health Act, 1970, the people who voted for those parties and who wished their representatives to represent them on the Eastern Health Board were denied their representatives. Wicklow County traditionally has had one representative from the Labour Party and one from the Fine Gael Party returned at successive general elections. County council membership has been at least 50 per cent and in some cases in excess of 50 per cent. Now those parties have no member on the Eastern Health Board.

I hope when the Minister takes a look at the operations of the health boards he will look particularly at the method of selection of members and change it so that the spirit of the Act, which was intended to give representation of the major political persuasions, will be upheld, and the method of selection tightened up to ensure the connivance which took place in Wicklow will not take place again. Joining a relative agricultural county like Wicklow to an urban and city county like Dublin has not helped the operation of the health services in Wicklow. Anybody who had anything to do with the health board in Wicklow will find the service has deteriorated over the past few years. The health board offices in Wicklow town are contained in one small, dingy room in the county council office. The section dealing with medical cards, and so on, is located some half a mile away in another office in a street which is almost inaccessible to pedestrian or vehicle traffic. This type of setup which has existed for several years will continue for an indeterminate period, it would appear. I hope the proposed offices which have been talked about by the health board for the Wicklow area will soon be provided.

This whole debate has gone on for the past year and when one raises the issue at advisory meetings he is told that the problem is lack of money. Included in a proposal from the Eastern Health Board to the Department was a condition regarding the provision of offices for the health board in Wicklow town together with the provision of extra space at St. Colman's Hospital in Rathdrum and the closure of almost all the Wicklow hospitals. It was conditional on the closing of Wicklow hospital that patients be removed from Wicklow to the new extension in Rathdrum and that the vacated areas in Wicklow hospital be used as offices for the health board. However, this proposal from the health board did not comply with the wishes of the people of Wicklow, who had not been consulted about the proposal at any stage. Recently I made representations to the Minister in this regard and he accepted the need for a continuance of the Wicklow hospital and agreed that the provision of offices should not be made conditional on the closing of the hospital. I trust that within the next year this ridiculous position of the health board will not be persisted in for the purpose of providing the administration of the health services in Wicklow town and county.

The operation of the advisory health board is of little benefit in this whole area because by the time we meet every two months reports are out of date and decisions have been taken already at the Eastern Health Board offices in Dublin. This situation can be illustrated by the appointment recently of a doctor in a Wicklow town, although nobody in that area was consulted in regard to the appointment. There was no consultation either with the advisory health boards or with public representatives in the area. The person appointed is an excellent doctor but there were several people interested in the appointment all of whom were well qualified for it. I am merely illustrating the method by which these decisions are taken, a method which allows for the bypassing of public representatives and others concerned. When the Minister is again considering the operation of the health boards, I trust he will realise the need for a return to the system of advice and discussion with local representatives in regard to appointments rather than to have the method by which people are nominated because they have a particular interest in a certain area. The concept of local democracy in this field of the health board's activities should be returned to and expanded.

Recently a deputation from Wicklow visited the Minister on the question of the provision of a hospital for the Arklow area. A very good case can be made in this regard because, as the deputation pointed out to the Minister, very many of the industries located in that area involve a high risk element. For example, there is the importation of such highly inflammable material as sulphur to the NET factory, the high octane fuels to the Jet Oil station and the domestic gases which are bottled and distributed in the area. In this situation there is always the possibility of an accident which could have serious effects for the whole area and which would require extensive medical facilities. However, the guidelines set out in the FitzGerald Report did not leave it possible to agree to our suggestion but we are happy that the Department have agreed to the provision at Arklow of a health centre which will provide a proper ambulance service for the area and also an accident service which, hopefully, will be sufficient to meet requirements in the event of any calamity in the area. It is hoped that the centre will be completed early next year. On a recent visit I noticed that the work is progressing. The centre should meet most of the demands made by the deputation.

While on that deputation I raised the question of the necessity of an expansion of the ambulance service in a county such as Wicklow in which there are many areas that are practically inaccessible. In order to be able to move patients at short notice it is necessary to have an adequate ambulance service. A survey in this regard was carried out recently in Wicklow and we hope that the results will be made known soon and that the necessary radio equipment will be provided in order to render the ambulance service fully operational even in the most remote parts of the county. At this time of year all parts of Wicklow are beautiful but the story is different during the long days of winter in so far as travel is concerned. That is why there is a need for this extended ambulance service and for the provision of highly-trained personnel to man the ambulances because in many instances patients have to be treated on the spot before being removed. I trust that the extension of this service will not be delayed.

The improvement in the disabled persons maintenance allowance is of particular benefit to those families who have mentally-handicapped adults. These persons are likely to have parents who are elderly and who are endeavouring to cope with the difficult situation of having a mentally-retarded person in the family. Very often they may require assistance from neighbours and friends and in this regard the provision of extra finance will be very helpful.

I wonder whether the Minister would be inclined to agree that the facilities provided for the adult mentally handicapped are inadequate. In many instances such persons are placed in establishments which were never intended to cater for them and which can do little for their improvement. Special centres should be provided for these people. However, at a time when there is a shortage of money, it may be thinking in the long term to seek such centres but it is wise to demand that these people are not forgotten and that the improvements which have been made in the last few years will extend to the provision of centres for their specific needs.

One part of the Minister's speech dealt with the activity of the Dublin Itinerant Settlement Committee. In his speech the Minister said:

Through the initiative of the Dublin Itinerant Settlement Committee, and the support of the Department of Local Government and the Eastern Health Board, arrangements have been made for the provision of accommodation at Newtownmountkennedy for 17 travelling children in need of residential care. This is an admirable undertaking and deserves our full support. The Eastern Health Board have recently had discussions with representatives of the committee regarding the future arrangements for the management of the accommodation and the continued support of the children during this year. I have every reason to believe that mutually satisfactory arrangements will emerge from these discussions.

I have had discussions with the gentleman who runs the home in Newtownmountkennedy and I am satisfied that the Minister's statement is in accordance with the facts. There are 17 children in the home but I am not satisfied that all 17 are getting assistance. I have been told that only six of the children are getting assistance. My information is not as recent as I would like it to be —it is two months' old—but I have been told that the other children are being kept there through voluntary subscriptions. I hope the Minister will inquire into this matter and ensure that assistance will be extended to all the children. The setting up of this type of home has met with difficulty in certain areas in Dublin. I should like to pay tribute to the schools in the Newtownmountkennedy area for accepting these children. There is room in the area for the setting up of another home but unfortunately there is a shortage of money. Many of the children being cared for in this home have spent a long time on the streets of Dublin. Some of them have had so many convictions in the courts that as soon as they appear before the judges they are dismissed.

On 16th June the EEC directive on doctors was adopted. It provides for the recognition of degrees and diplomas throughout the community. It also lays down regulations for the free movement of doctors throughout the community and deals with the maintenance of minimum standards of medical training. I heard of a lady doctor who applied for a post in a hospital in Luxembourg and was refused because she did not know the local language. Although she was qualified for the job her application was refused because she did not know French or Luxembourgese, which is a German dialect. She appealed to the commission but they had difficulty in making the hospital accept her application. However, representations were made to the Luxembourg Minister for Health and she was eventually given the job. I hope this excuse will not be used to prevent qualified persons from getting jobs in EEC countries because of the surplus in the medical profession in some countries. I am glad to note that the recognition of nursing diplomas is being considered and that the Minister has set up a working party. Since this working party was set up in the early part of 1975 they have reported to the Commission.

It is high time some action was taken by the Commission in regard to the adoption of a directive on nurses' diplomas. I have tabled an oral question for the European Parliament meeting next week asking what progress the Commission have made in regard to a decision on the working party's recommendations. I hope this question will get us some answer as to when nursing diplomas will be recognised throughout the Community. I hope also to discover if there is any prospect of retropsective recognition for people who have been working in England and elsewhere throughout the Community and who come back home and whether their years spent abroad will be recognised for pension purposes. I hope the Department will bring pressure to bear on the Commission and that the Council of Ministers will demand that the Commission produce a resolution for adoption.

Several Deputies mentioned a particular area and I should like to join with them. It is in regard to the number of deaths from motor accidents. This matter also involves the Department of Local Government from the point of view of regulations, into which a very strong health element enters. Statistics given by the Department are alarming. They show that in 1963 the number of deaths from road accidents was 286 and the latest figures available, for 1974, shows that in that year 562 people were killed on the roads, an increase of almost 100 per cent in 13 years. The motoring population have not expanded by anything like that percentage. This is an area of great concern and the figures show that in the coming year at least 500 more people will die on the roads, or perhaps as many as 600.

In the last few days I attended funerals of two such victims. Without attempting to lay blame in any specific area, this is a matter which must be looked at urgently by both the Ministers for Local Government and Health. Road deaths are taken for granted until they affect a person's own family and then we begin to look at them more closely. Up to a few years ago newspapers, particularly local journals, gave banner headlines to highlight road deaths. Now they are pushed into the back page of even the local newspapers.

I suggest that the driving test should be looked into, that people's general health should be checked before they are given a driving licence—that the whole driving population should be asked to undergo medical examination. Eyesight tests are particularly necessary. It may seem frivolous to say that certain motorists cannot see at all, but this seems to be the case. Many motorists either do not see or do not bother to see road markings. It is for those reasons that I suggest there should be an eyesight test. I repeat that I think all licensed drivers should be made to undergo a medical test.

The Minister made a reasoned case for the raising of limited eligibility qualifications for the health service for non-manual workers. Everybody in the House should be in agreement with the Minister's argument. The figure of £3,000 is not exhorbitant and, as the Minister said, it will bring back into the health services about 85,000 people who had lost eligibility. It would be unfair to exclude such a large number of people, particularly when we consider the toll inflation has taken of money values. There is a need to update considerably the 1972 figure which was £2,250. It is only logical that those earning £3,000 should be included and I hope there will be agreement on it fairly soon.

There is a small paragraph in the Minister's speech, at page 37, in regard to parents' attitudes to vaccination, particularly the three-in-one vaccination. The Minister stated:

I can understand that parents may have misgivings about this vaccination when they read of cases of brain-damage to children alleged to have been caused by the pertussis element in the vaccine but these parents should also consider that there is no substantiated medical evidence to prove these allegations. The medical profession are well aware of the known contra-indications to vaccination and where no such contra-indications exist vaccination is still recommended as an extremely effective tool against whooping cough and the other diseases I have mentioned.

I am glad he said that because certain parents have doubts that brain damage can result from vaccination. There have been radio programmes on the subject here and on the BBC. The parents in Britain have formed an association. They claim evidence to support that brain damage has resulted from vaccination and they have been demanding assistance from the Ministry of Health and Social Services.

I would hope that the Minister would ensure that if, as he says, there is no danger, this will be clearly indicated to all parents of small children because there are widespread misgivings as a result of the publicity given to certain people who honestly believe brain damage has resulted from vaccination. I hope the Minister will make an all-out effort to get the message across because parents of small children are very worried indeed. Radio was used to put across this particular idea and it should be used again now by an expert on the subject to reassure parents that there is no danger.

We have, as I said, the very extensive brief of the Minister and all the statistical information supplied with it. I believe we are all very appreciative of the Minister's work in these difficult times. Members are well aware of the need to extend our health services and they are also well aware of the limitations because of the scarcity of money due to inflation. Each year more money is required to keep the services going. The Minister, his officials and all engaged in administering the health services deserve our congratulations for maintaining the high standards they have maintained. The people in the area I represent are reasonably satisfied with the operation of the health services. Naturally everybody wants to see an extension of these services and everybody wants to see improvements and I trust the Minister will find some way to make the few improvements I have suggested in the health services in my area.

Mr. Wyse

We have, as the last speaker said, a very extensive brief from the Minister, so extensive it would be impossible to comment on all aspects covered by it. I will deal with those areas of vital importance. Forward planning is important and forward planning is not possible without fairly full information as to what moneys will be available for developments. The health boards have no really concrete information with regard to the amount of money that will be available over the years immediately ahead. They can assume money will be available but they cannot assume all the necessary finance will be available for desirable developments and so they cannot plan. They are disadvantaged and forward planning is just not on.

A proper health service is of vital importance and no one objects to spending money on such a service provided the expenditure will benefit the community as a whole. The cost of the health services continues to rise and will obviously go on rising. There are two questions we must ask ourselves. Are the people benefiting from the services? To what extent have the services raised the standards of health of our people? There is need for more research and more investigation into the health services so that, when we are reviewing the structure of our health services, we will have available to us all the essential documentation and statistical data and then, and only then, can we have a realistic assessment of our health services.

I mentioned the on-going cost of our health services and the benefits to the community. One must start at the base and the base here is the child. I recommend strongly that the Minister should review the service for the care of children—that is, the supervision of the development of the child. We are told that certain deficiencies appear at birth and disappear shortly afterwards but reappear later in the life of the child. It is important then that a special examination of the child should be made every six months over a period of two years. This should be a statutory obligation on the medical profession. The Minister may say the child is medically examined again in school life, but it could then be too late. I have in mind private nursing homes over which health boards have no control. It is important that we should have a more comprehensive child health service to ensure the prevention of subsequent ill-health. This would result in less cost on our health services in future. The Minister will have to give consideration to the position where private nursing homes are concerned. Are these homes complying with all the regulations demanded by the Minister? I have no doubt the Minister is well aware of what I am trying to convey to him.

There is a great deal to be desired where the general hospital programme is concerned. All hospitals should be equipped with essentials especially at consultant level. It is sad to see unfortunate people being transferred from one hospital to another for specialist treatment. I have seen unfortunate people transported from Cork or Kerry to Dublin. This is deplorable. When we are re-examining the existing structure of our hospitals this is one aspect to which we will have to give careful consideration. Costly though this might be it would nevertheless be of great importance to our people.

More could be done in the field of health education at all levels, in schools, universities, youth clubs, community associations and so forth. An approach must be made by the Minister to the Minister for Education to make health education part of the school curriculum. There is little point in talking about our health services if we are not prepared to start at base and introduce different aspects of health policy to all institutions.

Pre-school nurseries are becoming an essential service and must be developed under direct supervision, as there are many dangers involved. Those in charge must have the necessary qualifications. The premises in which these pre-school nurseries are held must satisfy the regulations in respect of fire and accident hazards. I understand there is an organisation here in Dublin set up specifically for directing such places. This service is very important, but it would be a terrible thing if tomorrow morning there were tragedies in these places that are now being set up as pre-school nurseries. If the people in charge of these nursery schools have the proper qualifications and if they are properly supervised by the medical profession, many defects that may have gone unnoticed as far as parents and other people involved are concerned can be detected in the medical clinics. Nobody should be allowed to set up a pre-school nursery without being issued with a licence from the Department of Health. This will ensure that the best service possible will be available to the children.

I welcome the Minister's statement that a White Paper on mental illness is being prepared by his Department. This is long overdue. An assessment of these services should be made at regular intervals. As the approach to the care of the mentally ill changes, those employed in this field must keep abreast of the different methods used in dealing with mental illness. There is need for more out-patient clinics. These clinics need not necessarily be in a mental hospital. Voluntary hospitals must be encouraged to establish out-clinics for mental illness. Voluntary efforts can also play a tremendous part where mental illness is concerned. They can help to rehabilitate people into normal life. I shall be dealing later with some aspects of voluntary involvement in community service councils.

The Minister and a number of other Deputies dealt with the rehabilitation of the physically handicapped. I do not intend to repeat the points they mentioned, but one aspect I would like to mention is that physically handicapped people undergo a lot of hospitalisation and many are deprived of educational opportunities. Some hospitals provide such a service, but unfortunately when the patient is discharged there is little or no follow-up and the young person is deprived of a vital service. One could imagine a physically handicapped person sitting in a wheelchair from early morning to late evening who cannot read or communicate with a friend. How frustrating this must be. Hospitals, the Department of Education and the Department of Health have a serious obligation towards these people. Community associations could make a valuable contribution in this respect by seeking out such people who are discharged from hospital and taking them to the community association at night to try to meet their educational needs. The Minister must have received many representations from the various bodies who are catering for the physically handicapped, and I would ask him to give this matter very serious consideration.

I welcome the interim report by the task force on child care services and I hope that the final report will be available shortly. It will be one of the most important documents to come before the Government because the development of the whole person is involved in the recommendations of the task force. The Minister is responsible for the setting up of the task force and he and the Government should be preparing for the implementation of their recommendations, including the provision of the moneys necessary. In common with many others, I am looking forward to the final report.

Alcoholism is becoming a dreadful disease. It is resulting in broken homes and in battered wives and children and it is also becoming a hazard in industrial life. More should be done to combat the disease. There is need for more education where drinking habits are concerned and the media, especially television, have a major part to play in highlighting the symptoms of the disease. Naturally prevention is better than cure.

Hospitals should be geared to cater for the problem. I should like to pay a special tribute to Alcoholics Anonymous and many other people for their work in this area. It is true that many hospitals are not catering for alcoholics. I have heard from doctors that there is a reluctance on the part of hospitals to admit a person who is suffering from this disease. Every hospital should have some beds allocated for alcoholics. Many of these people are not prepared to go into psychiatric hospitals but they are willing to enter a general hospital. Knowing the dreadful effects the disease of alcoholism has on the entire community, it is essential that special consideration and attention be given to the matter.

Unfortunately many of our young people are the victims of excessive drinking. It is a shame that so many young people spend all their leisure hours in lounge bars with little or no notice being taken by the people who serve drink to them. Part of the problem is that young boys and girls join private clubs where they indulge in excessive drinking. There is a need also to educate the parents to help their children with this problem. If they are to drink they should be taught how to drink and how to enjoy themselves rather than indulge in excessive drinking.

It is sad that so many homes suffer because of excessive drinking by both parents. One can imagine the example they are giving to their children. I would ask the Minister to help all organisations who are trying to combat this dreadful disease. RTE could play a major part if they arranged that once a month someone who is involved in this area gave a talk to the people. It is essential that a person should be able to diagnose his drinking habits. Unfortunately many people become alcoholics without knowing it. The media have an important part to play and they have a definite obligation to the community. They are well paid for their advertising of drink. All of us could do a little more to help the victims of this dreadful disease.

I should like to refer to the National Committee on Pilot Schemes to Combat Poverty as set up by the Government. The sum of £120,000 was passed by this House for the work involved. I believe there is overlapping of the work of the National Social Services Council as the terms of reference of both committees are somewhat identical. I do not know if the Minister has seen a pamphlet issued by the National Committee on Pilot Schemes to Combat Poverty. A very interesting circular was issued with it under the reference B-PRO 5/76. I have discussed this with a number of people and I think that something in the document needs clarification. That report states:

The Committee has been concerned since its establishment to develop a working philosophy consistent with its terms of reference. It has decided that:

"It is fundamental to the philosophy of the programme that poverty in Irish society should be recognised as largely a result of inequality and that its eventual elimination... will require a redistribution of resources and power in society..."

On the many occasions we have been discussing community involvement we were asked to give some explanation of "will require a redistribution of resources and power in society". I hope the Minister will comment on that when replying.

Where two bodies are set up by a Government there is a danger that they will be in conflict with each other. I am not objecting to the setting up of this committee but I believe there is a certain amount of waste of energy in this respect. It is a pity that the Minister did not avail of the National Social Services Council to take on this work. The structures were there and they have established themselves in organised groups of community associations throughout the country. The terms of reference of the committee set up to combat poverty is practically identical and the suggestions they are making involve the National Social Services Council and the various community associations. I cannot see why the Minister did not avail of the opportunity of using a structure which was already established by the Government and their predecessor. I do not wish to comment on a conflict that may arise between the community associations and the national committee on pilot schemes to combat poverty and I hope there will not be any conflict but nevertheless there is a definite repetition of work. The extraordinary thing about it is that some of the personnel on the committee to combat poverty, excellent people, also serve on the same committee of the National Social Services Council. We must be cautious in this regard. Community associations avoid repetition of services.

The whole spirit of community associations is to co-ordinate all the bodies working in some field or another where social services are concerned so as to avoid repetition in their work. More emphasis must be placed on voluntary community involvement. In this regard I should like to pay tribute to the many voluntary community services councils for the wonderful work they are doing for the less fortunate. Unfortunately, the allocation of money for these services has been cut and for this reason I believe the Government are not fully aware of the value those services are to the community. One need only look at the economics of the service. Health boards save a substantial amount of money because these community councils provide a service whereby old persons need not be permanently hospitalised.

I believe mistakes were made over the years. Millions of pounds were spent erecting or renovating institutions for our old people but such money should have been spent on services to keep those old people out of institutions. More must be done in the field of geriatric services. In this regard I should like to know how many geriatricians have been appointed. There is no point in talking about helping the old and the lonely unless we have a proper service within the hospitals and community. We all know that elderly people at some stage need to be hospitalised and for this reason it is important that we have specialised facilities available for them. Specialised treatment can only be given by a geriatrician. We are fortunate in having a geriatrician in Cork and he is doing wonderful work. It is important that we have more people of that calibre available to help our old people.

We all realise the value of the voluntary community services councils. They erect buildings and provide necessary services for the community from such buildings yet they have to pay substantial rates. In raising this matter I am conscious of the fact that the Minister for Local Government is present in the House. I am also aware that the Minister for Health, when questioned about this, has stated that health boards can come to the assistance of community associations in this matter.

Mr. Tully

Is this something new?

Mr. Wyse

What does the Minister mean?

Mr. Tully

The paying of rates on buildings.

Mr. Wyse

Yes.

Mr. Tully

I thought it was something we had started.

Mr. Wyse

No. I do not know whether the Minister has come in to interrupt or help with my speech but what I say is true. In talking of community service the greatest tribute must be paid to the late Minister for Health and former President, Erskine Childers. He was the architect of the community service system. He set up the National Council for Community Service in Dublin. Since then the service has developed, more people have become involved and it represents a saving to the State but it is a pity that people are burdened with rates. I ask the Minister and, perhaps, also the Minister for Local Government to give some recognition to the value of the great work done by community associations.

Many old people especially have the telephone service because of necessity. They may suffer from some serious ailment, such as heart trouble, requiring a telephone to summon a nurse, doctor or other person. This imposes a financial burden on them. Many such people were given what are called emergency lines. The State should consider assisting such people either by providing the service at a reduced charge or by paying the total cost of the service. It is easy to say one should do this or that without looking at the cost but if many such people were to be admitted to an institution or hospital, what would the cost be? A telephone to a person in that category is a friend, something to which they can turn in an emergency. I should like the Minister to get the views of health boards generally on this matter. The cost would not be great if one compares the cost of institutional care and the cost of a telephone and I think the telephone service would be worth while.

I have many times put down questions here regarding appointment of social workers. It is a pity that many young people leaving university with social science degrees must emigrate with tremendous loss to the nation. There is urgent need for more social workers to co-operate with the various community associations. To an extent they are leaders and they are of vital importance to community associations as guides and helpers of the voluntary workers on a full-time basis. We can go a little overboard on voluntary involvement. It is important but there is also great need for full-time, back-up services of the social worker and the public health nurse. These two form the nucleus of any worthwhile community service council. Yet, I have known many graduates in many parts of the country who have had to go abroad. One would not mind if there was no demand but there is a tremendous demand for them. I ask again that we give very serious consideration to recruiting more and more social workers.

In discussing the Health Estimate one infringes on other Departments. I hope the time will come when some Government will consider this aspect of the matter. In talking of something worthwhile regarding health services, one infringes on social welfare as in discussing youth, Education, Justice and Health are involved. It is hard to make a case without touching, perhaps, on the work of another Department. I think the time has come when the Taoiseach should seriously consider the structure of a number of Government Departments and see if they should be co-ordinated or their scope extended so that Deputies would have some opportunity to comment. I am discussing a service that is needed at present, a very important service, preparation for earlier retirement—not social welfare.

An Leas-Cheann Comhairle

The Deputy would be enlarging on the scope of the Estimate for which the Minister is responsible.

Mr. Wyse

I accept that but I am trying to establish that health is a very important factor where retirement is concerned.

An Leas-Cheann Comhairle

The Deputy will appreciate that in doing so he could be extending the scope of the debate to take in several Departments.

Mr. Wyse

I accept that ruling and I am sorry to be unable to talk on those lines: perhaps I shall have an opportunity on the Estimate for another Department. I want to refer to home help, another very important aspect of the health services. When we talk about keeping people out of institutions we must talk about somebody to look after such people. People helping in this field make themselves available to help and to call in and ensure that an old person is properly looked after in his or her own home but, unfortunately, the amount of money—I would not call it a salary— given to such people is certainly not attracting many to help in this field. We must give very serious consideration to this all-important service of home help.

I have touched on a number of points but in trying to establish a case on different aspects of health one infringes on other Departments. It is important for any Government to ensure that we get the best contribution in a debate on a matter such as health by bringing in other aspects of Departments where there is a linking-up with health. This would give me and many others a greater opportunity of stressing some of the points and urgent needs of our people where health is concerned.

I hope the Minister for Health will give serious consideration to having a look now at the whole structure of our health services and that the necessary documentation and statistical information will be made available not alone to Members of the House but to members associated with health boards and so on so that we will all have an opportunity of producing a worth while health policy.

Mr. Coogan

This is a colossal sum, practically £250 million for the health of this nation. Even on that we have an increase on last year of 13 per cent. This covers the ever-widening field and it is of interest to note the Opposition crying out for extra services. When the great provider, the Minister for Finance, Deputy Ryan was subject to barracking to provide the moneys for the different ministries, what help did he get from the Opposition? That is the name of the game, I suppose.

This is a colossal sum for the health of the nation and it is not the first time a National Coalition have put health before wealth. I recall a time when the great white scourge hit this country and had been hitting it for generations, the white scourge of TB. It was a Coalition that tackled the problem when the Government before that had left people to die in old homes merely providing beds for them. I recall in my town many fine boys and girls being wiped out. Thanks be to God there was a change of Government which stopped that. We have seen the health of the nation improve with the great decline in TB.

Wealth meant health in those days. One who had enough money could go to Switzerland for a cure. People who had not could go to the different old county homes, as they were at that time fit for nothing else. But now I refer to health, meaning that it has a lot to do with wealth. There are a number of people today who have the name of wealth, who have the signs and, we might say, the symptoms of having wealth by having nice homes, but who are put to the pin of their collar to provide the wherewithal to keep these homes and meet their commitments. The result is that there is a tightening of the belt behind that facade of a wonderful home at times to provide the staff of life and there is a certain amount of deprivation and worry. Naturally, the table suffers. When the table suffers the health suffers. Further to that is the depression caused by these people not holding a medical card, borderline cases at times. Maybe they try to keep up with the Jones's and are paying the price but then their health suffers and they are caught.

Then, in order to keep families small there is a demand for contraception. That is the last straw. As far as married people are concerned, I will not comment further but there are other elements abroad who are crying out for contraception, for its free availability and if they get that they will demand abortion. Man has the God-given right under certain conditions to create life but under no condition has he the right to kill the unfortunate unborn. As far as this country is concerned perish the thought of abortion or free contraception. I was never more disgusted to hear a lot of the demands from people. I think in the background of all this are the merchants who are out for the quick buck, using this propaganda for their own ends against the youth of the country. If we give way in this field, we will be blamed by generations to come as having failed and the finger of scorn will be pointed at us. I was never more disgusted than one day recently coming through this gate to see a parade of young women, unashamed, without rings on their fingers, demanding free contraception. What is the world coming to at all? I am no paragon of virtue; I could strike my breast and blame myself for a good many things in life. But certain standards were handed down by our forefathers which should not be given away to these quick buck merchants out to use our youth for one purpose only, that is, that they get in on the floor and make something out of it.

With regard to drugs it is my humble opinion that they are being overprescribed at present. I say that with due respect to the medical profession. I have seen homes where dressingtable drawers have been overflowing with pills of various types. An unnecessary amount of drugs seems to be given out to people at present. Perhaps it is regarded as a handy way out, with doctors saying: "Here, take this, go home and try it out; see how it works and, if it does not, I will give you more." However, it is not for me to go into too much detail in the medical field. But there is something wrong when one sees their effects in certain homes. The question arises: are people becoming too dependent on drugs? There seems to be a case for a tightening up on their prescriptions and I am not referring to medical card holders only. I know the Department of Health utilise television programmes in respect of certain health matters. I should like to see greater use of television in this respect because, like the Press and the written word, television has a great impact. It would be money well spent on advising people generally on health matters.

The importance of first-aid—a branch of surgery in itself—cannot be over-emphasised. The important factor to be borne in mind here is to keep the person alive and, if possible, prevent further injury. Again this could not be better demonstrated than through television programmes. The Department of Health should do something in this regard, with so many of our people being crippled and injured on the roads, with bad handling by the public generally, which merely adds to the injury and, at times, may even be the cause of death. Simple first aid may prevent an unfortunate person from dying, be it through artificial resuscitation or the prevention of haemorrhage. The Department of Health could play a large part in informing our people in this respect.

Alcoholism has been touched on. Now and again the Department have given us an insight on how an unfortunate person should draw the line in this respect. They should continue in that vein because it is something we tend to sweep under the carpet in this country, the attitude that so many are "with-it"—if that is the term to be used—it could not be wrong; we have to accept it, and we accept more than we can take. I heard one man say recently if the pint went up to £1 he would follow it.

I should like to see psychiatric treatment for adults being extended. The mental hospitals catering for people are not suitable. Unfortunately there seems to be a certain stigma attached to mental illness in this country similar to that attached to TB heretofore when people avoided families with it. Thank God that day has long since gone. I hope the stigma of mental homes will disappear also. There seems to be a certain reluctance on the part of an alcholic needing treatment to enter such hospitals. There is a special case to be made for such treatment when one measures the amount of man-hours lost in industry, the inroads made into the health not alone of the unfortunate himself but that of his family also.

I wonder if the public free chest X-rays are easing off. If they are it is a retrograde step. I hope I am wrong but I have not noticed the van around recently. Perhaps it would be a good thing were we to have some system of free blood pressure tests throughout the country. That would be preventive medicine in itself because we know that blood pressure problems lead to strokes, coronaries and so on. Prevention is better than cure and such tests would show up early signs of problems. I do not think it would cost a lot. A nurse could take a person's blood pressure and, if she found somebody suffering from blood pressure, she could recommend him to a doctor. That is the time to receive treatment, not when one has suffered a stroke, coronary or something else. Such a scheme would indeed be worthy of implementation.

I sometimes have to attend dances to support some cause or other. As a public representative one has to attend many such functions. However, I am most reluctant to enter dancehalls at present except in an endeavour to support some worthy cause. I would like the Department to investigate the effect loud amplification in dancehalls has on the ears, if not the nerves, of children. If I was in one of those dancehalls for long my ears would be affected. The Department should have some way of measuring the decibels of those amplifications. I would also like to see proper ventilation in dancehalls. We have often heard talk of foam baths but one would get a foam bath in many of those dancehalls.

I would like to pay tribute to our Air Corps for providing helicopters for ambulance services. They have helped to save many lives. It is only right and proper that we should pay tribute to those men and also to our lifeboat service. I have seen lifeboats come to the rescue of ships in distress in very bad weather off the west coast. Those men endangered their own lives to save the lives of others. When I visited the great fishing area of Brittany in northern France I was asked by the leading skippers of the fishing trawlers of very large tonnage to convey their appreciation to the nurses and medical staff in the hospitals in the west for the way they have treated sick and injured fishermen who have been brought in on many occasions. I would like to pay tribute to the nursing staff in Galway hospital for their dedication to their patients. The nursing staff are often subjected to bickering by patients who, because of their illness, may not treat them in a proper fashion.

We should all think about the Third World. One often sees on television a human skeleton from the Third World and then we hear about the mountains of beef and powdered milk. The World Health Organisation should play a bigger part in relief for the Third World. Those people are our brothers, irrespective of what colour their skin is. Something should be done to use the milk mountains to help those unfortunate people. When one compares conditions in Ireland with what we have seen in countries in the Third World we know how well off we are. There may be a repercussion if we close our eyes to the Third World. What happened in 1918, when we had the great 'flu epidemic, is within the living memory of many. It was said that this came as a result of the millions who died on the battlefields of France. We do not know the effect famine in the Third World may have on us. We have a lot to account for if we fight about the green £ but do nothing about our brethren dying on the other side of the mountain.

I would like to compliment the Minister for providing a home for the aged in my town. It was very hard on people who had to go to the county home in Loughrea. This is a very excellent home but hardship was caused to aged people there because their relatives could not afford the cost of transport to visit them. This has been a very sore point with the unfortunate people who have to stay there and had no friends to visit them. Those people were poor. The song known as "The Irish Emigrant" tells us that the poor have no real friends. I am not saying those people emigrated when they went to Galway county home but many of them were unable to have visitors because their friends could not afford the cost of transport to visit them. I hope to see more homes provided like this new one in Galway.

Many people said that after the home was provided no staff were provided. It is a good thing to see that voluntary staff came forward to open that home. I wish to thank those people publicly for coming forward. Many things in the past were got by voluntary effort. That was how we got our freedom although we may have paid a fair price for it.

I would like the Minister to look into the few points I have mentioned, particularly into the loud sound in dancehalls and the effect it is bound to have on young people. When I was young and we went to dancehalls we had to serve our time before we shook the floor. Nowadays young people can go into dancehalls and shake themselves as they like. In my young days we had orchestras which had not a deafening effect. Some of the Opposition Deputies derided the great provider, the Minister for Finance, because of extra taxation but they are calling out for more money for our health services. They cannot have their loaf and eat it. Sin an méid atá le rá agam.

An Ceann Comhairle

Deputy O'Connor.

Debate adjourned.