Health Contributions (Amendment) Bill, 1977: Second Stage (Resumed) and Subsequent Stages.

Question again proposed: "That the Bill be now read a Second Time."

Before lunch I said that this was simply a money raising taxation measure. Since last year we have seen a 50 per cent increase from £12 to £18 per annum without a corresponding increase in extra services or facilities. I then went on to deal with care of the aged and spoke of the ambulant geriatrics who are very adequately looked after in welfare homes. I then dealt with the non-ambulant geriatrics who are cared for in private nursing homes. I asked the Minister if he would provide adequate subvention for the maintenance of these people. I would like to pay tribute to the public health nurse. She plays an extremely important part in meeting and providing services under this——

That would not be relevant.

Paragraph 2 of the explanatory memorandum reads:

(a) hospital in-patient and specialist out-patient services,

(b) maternity and infant care services and ...

I gather that many of these services are provided not alone through the hospitals but also through health centres.

We are dealing with dependant limited eligibility.

May we discuss eligibility for services that are provided in many cases through the health centre system? Would I be out of order in discussing that?

The Chair is saying that dealing with public health nurses at this stage is not relevant to the Bill before the House.

If a person qualifies under the legislation passed in 1976 and this current legislation for services which are rendered through centres such as health centres, the public health nurse would play a very important part. I did not think I was straying too far from the Bill before the House but I accept the ruling of the Chair. I had intended to elaborate a little on psychiatric social workers who are important personnel in those services.

It would not be appropriate to this Bill.

I gather it would be appropriate to speak about the financing of health in general terms. The Minister referred to it in his brief and it is also mentioned in the explanatory memorandum.

The Deputy is aware that it would not be appropriate to go into detail on matters at this stage. Perhaps the Deputy would reserve those comments for Committee Stage.

Perhaps I could seek guidance from the Chair as to what point on Committee Stage I could raise the matter. The Bill contains only two sections.

The Deputy may make a passing reference to these matters but he cannot go into them in detail.

I am sure the Minister agrees that quite a few people qualify for services but there is a huge backlog that has to be dealt with. I had hoped that if there was an increase in the number of social workers and public health nurses that backlog might be eliminated.

In my constituency there are huge numbers awaiting dental treatment and assessment. This is not the fault of the senior dental surgeon and his staff. They do tremendous work but they are handicapped by the huge numbers who are entitled to services and, in addition, the conditions under which they work impose limitations on them. It appears that two of the 700 new jobs the Minister mentioned will be coming to the constituency; I understand we will have a dental officer and a dental assistant. However, even though it is some step along the way it does not go far enough.

At the moment we have wonderful lay personnel who do tremendous work. We also have extremely zealous and dedicated religious people who give much of their time to this work but as the numbers in this group decrease the costs and charges for health will soar. This is a factor that I hope will be brought before the new committee. I hope the Minister will tell us what financial commitment he is prepared to make, in conjunction with the Minister for Finance, to the health board in the way of adequate grants for the maintenance of geriatrics in private nursing homes who offer an excellent service.

Having heard the Chair's ruling with regard to Deputy Murphy's speech, my contribution will be brief. If it were left to me to decide whether this Bill should be accepted, I would be inclined to oppose it because the people I represent will not be getting full and reasonable health benefits. I refer to the situation that exists in relation to the county hospital in Roscommon.

These people who make contributions to health or other services expect that those services will be as good as in other areas. For this reason they must be concerned about the way the contributions are being used. I understand the advice given by Comhairle na nOspidéal to the Minister was that the maternity services in Roscommon County Hospital be withdrawn. If these contributions are used to implement that decision, they will be put to a wrong use and, to a certain extent, to an illegal use. I understand that section 41 of the Health Act 1970 does not empower Comhairle na nOspidéal to decide on the closing down of any institution. I have also been advised that section 38 is the operative section for the use of this money when it is contributed by the people concerned. Under that section there is an obligation on the Minister and on the health board to provide hospital services. Having made a decision that they are necessary and must be supplied, the Minister asks Comhairle na nOspidéal to advise him on the staffing.

Section 41 of the Health Act, 1970, states:

(b) The functions of the Council shall be—

(i) to regulate the number and type of appointments of consultant medical staffs and such other officers or staffs as may be prescribed, in hospitals engaged in the provision of services under this Act;

It is obvious that they have no legal power to decide on the closing down of maternity services in the hospital. This is something that rests solely with the health board with the permission of the Minister. I should like to know from the Minister in his reply if he has prescribed for Comhairle na nOspidéal the duty of making the absolute decision as to whether maternity and gynaecological services should continue in Roscommon County Hospital.

Section 38 (1) says:

A Health Board may, with the consent of the Minister, provide and maintain any hospital ... under the Health Acts, 1947 to 1970.

I submit that this is where the authority lies in relation to deciding on the closing or regrading of hospitals. Subsection (3) of that section reads:

A health board may and, if directed by the Minister, shall discontinue the provision and maintenance of any premises provided and maintained by it under subsection (1).

Here, again, I have no doubt that the people I represent and the people that this Bill will ask to contribute under the Health Contributions Act to the maintenance of those hospitals would expect and believe that nobody but the Minister would be the final authority on this matter. Subsection (5) of section 38 reads:

The Minister shall not give a direction under subsection (3) in relation to the discontinuance of the provision and maintenance of a hospital, sanitorium or home save after having caused a local inquiry to be held into the desirability of the discontinuance.

Would the Minister indicate when that local inquiry will be held in Roscommon so as to comply with subsection (5) of section 38? This is a very serious problem and it is one which it is alleged politicians coming into this House regard as purely political, with the interest of influencing votes at future elections. In my present state of mind I do not think that charge can be made against me. I am a medical practitioner operating in north Roscommon. No doubt a large number of the people in my area will have to make contributions under this legislation for the maintenance of those hospitals and, having made their contributions, they would like to think that the hospital services provided for them would not alone be adequate but be within a reasonable distance of them so that they could reach them with a reasonable amount of comfort at the most unpleasant times of the year. Otherwise some injustice will be done to them by asking them to make contributions under this legislation in the circumstances that the alternative offered to them is to travel, perhaps, 60 to 70 miles to receive maternity assistance and maternity treatment.

It may be suggested they will find alternative accommodation which may be provided for them in Sligo, which is the nearest hospital to north Roscommon, and that those contributions will be used for providing that accommodation. However, this accommodation is not there at present. I am fully aware that all the maternity accommodation of the Western Health Board is taken up at present and I think it is true to say that without the maternity beds in the Roscommon County Hospital the Western Health Board have not sufficient maternity beds under their control to cater for the needs of the area. This is a basic medical fact which, as far as we are concerned, takes all this out of the realm of politics.

A further proof of this is that the Minister has stated on a previous occasion that he had intended, as a first priority, to help the Western Health Board to extend Castlebar, and that the second priority was the extension of the number of maternity beds in the regional hospital in Galway. No doubt the money he proposes to collect through this legislation will be used for those purposes. The fact that he is proposing to establish extra maternity beds indicates without any argument that there are not enough maternity beds there at the moment. Without providing the extra maternity beds, and removing the 26 beds that are in the Roscommon County Hospital, he will aggravate the situation and will be coming back to this House for a further increase in the health contributions so as to overcome the problem.

In regard to the proper use of the moneys that will be collected by this legislation I hope the Minister will inform the public who will be paying the contributions that he is prepared to make use of the powers he has under section 38 of this 1970 Health Act. I understand that the CEO will make use of his legal powers—I have not been talking to him but this is what I gather from the local papers —to decide that the unit will continue and then the Minister will be faced with making a decision whether it does or not. I suggest he must make a decision to keep those beds and that, if he decides to discontinue them he must hold a local inquiry in accordance with subsection (5) of section 38.

The local inquiry is not defined fully in the subsection but I have no doubt it will be the type of inquiry which will be accepted by the people as a full inquiry into all the facts, figures and the difficulties and responsibilities that a hospital unit would have in the community. If that is properly conducted, I have no doubt the Minister will be persuaded to accept the decision of the CEO and at that point I submit that he asks the advice of Comhairle na nOspidéal as to what the staffing of the unit should be.

I agree there is this difficulty of having one obstetrician-gynaecologist or two obstetrician-gynaecologists in a unit in relation to the number of people who are in the hospital. This, I agree, is a proper consideration in view of the fact that a Minister has to seek authority in this House for requiring people to make contributions for the maintenance of not alone the hospital but the people who will staff it. Comhairle na nOspidéal may say to him that there must be two of those people, that there is no justification in the circumstances for having them and that people should not be asked to contribute for this purpose. However, they have already agreed to establish one surgeon in it and I believe they could start with one obstetrician-gynaecologist. I have no doubt that, if the services are provided there on a proper basis with qualified people, over the years, with the return of the people of the catchment area to the hospital when proper services are provided for them, and with a further increase in population in the area, eventually the establishment of a proper maternity unit with two obstetrician gynaecologists will become a reality. Then, the Minister will be justified in coming here to seek support for this legislation and subsequently, with the legislation he will be justified in asking my constituents to contribute to these funds.

I apologise that frequently during my contribution I have used the phrase "contributions to the health services" but I expect the Chair will understand my position.

I rise to make a short contribution to this debate and to emphasise what appears to be an anomalous situation in one regard. Some of the increases announced by the Minister are extraordinarily large. He has announced that it is proposed to increase hospital maintenance charges by 30 per cent with effect from April 1. In a way this can be compared with the 20 per cent increase in the cost of stamps and the extra 20 per cent or £3 referred to in section 2 of the Bill. The Minister mentioned that the Minister for Industry and Commerce had sanctioned this proposal. Indeed, the latter seems to be sanctioning all proposals for increases. The Minister for Health and Social Welfare went on to say that he would arrange with the VHI that their subscribers be afforded the opportunity of increasing their cover to provide for the revised charges.

The headlines in today's papers refer to the increases being sanctioned for Members of the Oireachtas but to endeavour to put the matter into perspective I might cite what the increase envisaged in VHI contributions, for instance, will mean to me. My annual contribution is in the region of £150 so if I increase that by 30 per cent I will be paying an extra £45 per year or, almost £1 per week. That represents an immediate and extra diminution of any extra benefits I may receive by way of salary.

My purpose in speaking this afternoon is to suggest to the Minister some ways in which savings in expenditure could be effected which would leave it unnecessary for him to seek so much money from those in the limited eligibility categories as well as from the workers who must pay the piper all the time.

The case I want to cite concerns a constituent, the holder of a medical card, who came to me recently to complain that, after a visit to his local dental clinic where he was given a prescription for medication in respect of pains in his gums, he was charged almost £3 by the chemist to have the prescription compounded. I am not a member of a health board but my understanding of the situation in so far as medical cards holders are concerned, is that they are entitled to have their prescriptions compounded free of charge. However, I took the complaint up with the appropriate officer in the Midland Health Board and he referred me to the senior dentist at the clinic —Deputy Haughey tells me this is the person known as the orthodontist— and he, in turn, explained that there was a problem here and that in order to have the prescription compounded free of charge the person concerned should have taken it to his doctor who would have duplicated it. The man could then take the duplicate to the chemist who would not charge him for the medication. Otherwise the medical card holder is treated as a private patient for the purpose of the prescription. The orthodontist told me that there is a problem in this area and that although they have been endeavouring for some time to have the situation resolved with the Department of Health, they do not appear to be getting anywhere.

Is it the position that the medical profession are opposed to a change in the regulation in this regard? In any case, the point I am making is that there is wastage in this area and I should like the Minister to refer to the position when he is replying. Is there a need for a middleman in respect of such prescriptions? Does this not represent unnecessary expenditure in that the doctor is paid under the Health Acts in the same way as if the medical card holder had consulted him about some health matter? This practice represents an additional £2 or whatever is the figure agreed between the Minister and the doctors in that regard. It is an additional charge falling for payment under this Bill.

Perhaps a person would be better off taking an aspro and hoping for the best.

Perhaps I am making all this sound very complicated but I see no need for a doctor merely to fulfil some regulation to have to duplicate a prescription written by a dentist. Can the Minister explain why that is so, or whether there is an objection from the dental side? Is it possible to have this thing looked at? A tremendous amount of money must be spent by the various health boards. This is only my experience of this operation. I was told by the senior dental surgeon who spoke to me about this, that this is a very costly extra as he sees it, that has to be met by my health board. I presume it is the same all over. I am drawing the Minister's attention to this with a view to seeing if the practice could be eliminated.

Possibly Deputy Lalor knows exactly what the case was. I could not follow it. Apart from the various people who were involved in providing orthopaedic treatment, the fact is that nobody who holds a medical card should have to pay, as Deputy Lalor said, £1.50.

It was £2.50.

I will inquire into it. The Deputy also suggested that this might be the practice in other health boards. I will look into that as well. I thank the Members of the House who contributed today on the Health Contributions Bill. The one noticeable thing was that there was not much if any mention at all of the amount of money provided. The tenor of the debate about this time last year was to the effect that there was not sufficient money. I do not know whether Deputies are satisfied or gravely surprised that there has been a pretty steep increase. We talked this morning about possible extravagances, waste and so on in the health services but the speeches requested and demanded that more money be provided for this, that and the other. I do not object to this nor would any Minister for Health. There are reasons for these demands to which I will refer later on.

I will give the House some idea of how health expenditure has increased in recent times. I will take it from 1972-73 merely because health has been my responsibility from March, 1973. I do not make comparisons to throw them in the face of Fianna Fáil or anything like that, because there are factors which necessitated the increase in the cost of the health services. In 1972-73 the amount met from the Exchequer was £76.7 million. Over the years that increased by fairly substantial amounts until it is now £299.7 million—that is for non-capital expenditure. In the Book of Estimates the figure is for £289.7 million but the figure I have quoted includes the £10 million which the Minister for Finance announced in the budget would be allocated to the Department of Health for specific purposes. That increase by any standards, I suggest, is an indication that we are meeting our obligations towards the health services and that we are improving them. Capital money has risen from £6.6 million in 1972-73 to £16 million. This includes £6.8 million for new starts.

Deputy Haughey and I are at variance as to what the GNP would be in 1977. Far be it from me to challenge the figures that he gave in the absence of certain information. Over the last four years the percentage of health expenditure of gross national product rose from 4.8 per cent to over 6 per cent. I said 6.5 per cent this morning. It may be proved right or wrong, but it does not matter at this stage. It will be very pertinent, as suggested by Deputy Haughey, when he comes, within the Select Committee, to consider the overall health services. It will be seen that health expenditure has risen very rapidly in recent years, not alone in money terms but in terms of a percentage of the gross national product. The services have improved rapidly. The House agreed this morning that it was time to take stock and to assess the future of health care. This view has been expressed over a period by all sides of the House and I feel that all parties should have a chance to participate in discussion through the representatives which they nominate.

The number of personnel engaged in health services in this country is not widely known. I am not referring entirely to people employed by the health boards, but also to those in all the health agencies. The number has risen by 12,000 from 1972 to 1977. That is a pretty substantial increase. These people represent a big proportion of the population and are giving extremely good service. I will give a few examples of those increases. These will not make up the total of 12,000 extra to which I have referred, but it will give an indication of the improvements that have been made as far as personnel is concerned and more importantly as far as the services are concerned. In 1972 the amount spent on home helps was £150,000. It may be that the scheme did not get off the ground for a few years, but at that time, in 1972, the expenditure was £150,000. Deputies have stressed the importance of home helps and the desirability of keeping people out of institutions, particularly old people. This is also reflected in the number of home helps that we have at present who constitute a substantial portion of the 12,000 extra jobs. There are now 4,800 home helps employed in the health services by the various health boards whilst in 1972 there were only 500. Deputy Leonard mentioned this and advocated that more home helps be employed. I can safely assure him that even within this year there will be an increase in the number of home helps. There have been an extra 100 junior hospital doctors, 150 extra laboratory technicians, ten additional senior dental officers and 35 additional wholetime dental surgeons. If money and numbers employed are any guide it must be admitted that over the past four years there has indeed been a vast improvement in our health services.

There was not much mention today of the number of people covered by medical cards or complaints about withdrawals. Inevitably there will be withdrawals during the year, but people will be inclined to think about withdrawals rather than the number of people newly issued with medical cards. That has shown a substantial increase in a great benefit to those covered by medical cards. Again I quote figures to show the improvement there has been. In December, 1972, there were 864,106 people covered by medical cards and that represented coverage of 28 per cent of our population for all the health services. This in December, 1976, had risen to 1,193,909 which now means that 38 per cent of the population are covered for all the medical services. I know there are many on the border line who have £1 or £2 above the amounts laid down by the chief executive officers, but of course there will always be hard cases, not alone in this group but in the middle income group as well.

When I took office there were guidelines set down by the CEOs and they differed vastly right across the country. As a result of questions asked here in the Dáil and of having the matter raised in other places I decided that I would see the CEOs to try to ensure that the guidelines would be uniform. That is the case now and there is no difference between the guidelines in any part of the country, in any of the health boards or in any of the counties. These guidelines are reviewed at least annually. There was a time when the review would not take place for well over a year or perhaps two or three years. Now, having regard to the increase in the consumer price index and to the movement as far as wages are concerned, not alone are these guidelines reviewed annually but they are reviewed twice during the year because conditions can change in a year and it is only fair that they should be reviewed as they are now, twice yearly.

A big question that concerns us all is the rising cost of the health services and whether or not value has been achieved. It is very difficult to say whether or not that is so. I have made several comments on this during the past year in the Dáil and at various medical functions, and I hope there is an awareness amongst all those who are practising in the health services, particularly the health boards, of the importance of giving value for money. I am afraid there are sub-organisations in the medical profession who do not seem to have appreciation of money and costs. I will not say that this is widespread but there are some who do not seem to think in terms of money at all but who believe that if something needs to be done, improved or introduced, all they have to do is ask for the money and it will be given to them. As a result of the taking away of the health charges from the local bodies over the last four years when these charges were reduced each year—they are now nil— we have a situation where the health boards have no responsibility, or else a minimum, maybe 1 or 2 per cent responsibility, for health expenditure. It was Government policy, a good policy, to take these health charges away from the local rates, and the health boards have behaved responsibly as far as the submission of estimates for the health services is concerned. However, it does leave the Minister in the invidious position where he pays for all these services and the public representative has not the same responsibility as he had when the local rates provided 40 per cent of health expenditure. Members of the health boards, many of whom are members of county councils, were very much aware of the impact on the rates when the health charges were part of the rates.

In so far as value for money is concerned, we have endeavoured within the Department by circular to the health agencies, health boards and so on, to emphasise the importance of value for money. In order to try to reduce the drug bill we also have had a working party on drug prescribing and their recommendations are now being implemented. I hope and trust that those engaged in prescribing will have regard to the cost, but not of course by reducing the quality as far as the patients are concerned. I also have in the Department some additional staff employed to see how the money is spent and to try to improve management in the health services. Outside consultants have been and will in the future be helping us in this regard. This aspect of the matter will also be looked into by the Special Committee which was agreed to this morning.

We should not think that we are the only country in the world faced with rising costs and rising expenditure, particularly in the last decade or so. It is a world-wide problem, it is a problem for our nearest neighbours and certainly a problem in the USA where health care expenditure had quadrupled in the last ten years or so. Therefore it is apparent that governments must try to solve this problem and we too must tackle it in any way we can. We must not alone provide the best services we can but we must try to get them at the best price we can in the interest of the taxpayer.

I appreciate the attitude of those who are demanding more and more services, more and more hospital beds, more and more attention and who are demanding that the waiting list be reduced. Increased demand is a reality. It seems to be pretty limitless. It has been brought about mainly by two factors. Improved techniques and technology are responsible in themselves for a growing demand. About ten, 15 or 20 years ago technology and techniques were not of the high order they now are. There was nothing to be availed of, so to speak. Now people believe, and rightly so, that most ailments are curable. The results of tremendous research have shown that many ailments which were previously regarded as chronic are now curable. There is also the factor of improved knowledge among the population of the value of health care. This has led to a growing demand as well. Another small factor which must be mentioned is that people are becoming much more aware of their entitlements under the health services and are duly presenting themselves to their doctors and various other members of the medical profession.

There is no sign of the demand slowing down to any extent. On the contrary, it is increasing rapidly every day. I should like to give two examples, and very deserving ones. There has been an explosion in the demand for services for the mentally handicapped which I believe is to be welcomed. It reflects the growing social concern about the needs of the mentally handicapped. As I said in this House before, people do not now tend to hide this type of illness, and rightly so. I was appalled on one occasion on visiting a house where there was a mentally handicapped child to discover the child was put away in some remote room so that the neighbours would not see the child. As in the case of TB years ago, people now freely recognise that this illness is curable. They realise treatment, occupational therapy and general care are provided for the mentally handicapped. Progress has been made in that respect. I say progress. I certainly would not say the problem is solved. In the past four years, 1,000 residential places were provided for the mentally handicapped. That still does not meet the needs of the nation but it can be described as a pretty good improvement.

Yesterday we had a question about hip replacement. The demand for hip replacements has also been increasing. Over the past few years new techniques have been employed to help persons who found it very difficult to move about let alone to walk. We also have the problem of drug prescribing to which I referred a few minutes ago. It seems to me that doctors and those in the profession who may prescribe drugs should give consideration to the amount of drugs and the cost of the drugs they prescribe. It is very difficult to resist demands most of which are genuine. I have given two examples and I could give very many more.

There was a suggestion that health costs should be met from a national insurance scheme instead of from taxation as at present. A working party has been set up on the financing of the health and social welfare services and I expect there will be a report this year. If we are to move from taxation financing to weekly insurance premiums we will have to raise something like £316 million from those premiums, that is, if the insurance scheme is to cover all the costs. Even if we assume that the insurance scheme would cover only half——

I do not want to be impolite but the Minister is moving away from the Health Contributions (Amendment) Bill. I stuck fairly rigidly to it.

I do not think I am alone in that. Perhaps the Deputy was not in the House all the time. Is the Deputy suggesting I am out of order?

The Minister should be setting an example.

Last year I tried to confine the debate to health contributions. When the Chair challenged the Opposition with being out of order they made a request and it was acceded to, and we had what were, in effect, Estimate speeches. I do not propose to keep the Deputy much longer. I was just saying what I think. I was saying it without prejudice or criticism of anybody. I was stating the facts as I see them and the problems which confront us.

Even if the insurance scheme were to cover only half the health expenditure, £158 million would still have to be raised in that way and the balance provided by the Exchequer. This is not in deference to what Deputy Haughey said but I have completed what I wanted to say generally. The Select Committee will look into this matter as well.

The Deputy was quite unfair when he said the increase of 6p per week represented an increase of 50 per cent in 12 months. I do not know how he got that figure. This is the second increase since this time last year. The 1976 and 1977 increases combined would be 50 per cent but that would cover a period of two years. I do not think there can be much of a quibble about the extra 6p, particularly when one has regard to the pattern of the increases over the past six years. On 1st October, 1971, when the scheme was commenced the weekly contribution was 15p; on 1st January, 1975, it was 26p; on 1st April, 1976, it was 33p; on 1st April of this year it will be 39p. An increase in the contributions from 15p in 1971 to 39p in 1977 cannot be regarded as being exorbitant. For those who receive the services it is pretty good value for money, not alone in respect of insured workers but also the other two categories.

The Deputy also asked what kind of jobs will be created. I referred to the sum of £7.5 million. The extent and number of jobs which will be created by this additional finance which was allocated in the budget cannot be determined until final decisions are taken on the allocation of this money. Deputies are possibly aware that there are discussions going on—many of them may be finalised now—with the health boards to see what proposals they have and what the employment content is. Some people believe this is money that will go to the top bracket of the medical profession but this is not so. The number will run into many hundreds and the personnel involved will include public health nurses, social workers, child care staff, home helps, general nurses, para-medical staff of all kinds, maintenance staff, domestic staff, staff in homes for the mentally handicapped, doctors and dentists, to mention just some. This will enable a considerable improvement to be made to the services also; it is not merely job creation but also means of improvement in the health services.

Deputy Haughey also referred to the burden of voluntary health insurance through the increase of 30 per cent in charges. VHI premiums are subject to income tax rebate which greatly benefits many contributors and I believe that private patients, even with the increase, still meet only half the economic cost in the major teaching hospitals. Deputy Lalor complains that it will cost him possibly another £1; I am sure he does not regard himself as the average salaried man but I think he would certainly agree that he would get good value from the VHI.

If one takes a man and wife and two children with no eligibility for treatment in a semi-private room—I think this would be a typical example—the voluntary health insurance would amount to £106.50. The tax rebate would be about £37.50 and the net cost £69 per year. I would not consider that an undue burden considering the cost of hospital services.

Deputy Haughey also asked me about non-manual workers who were voluntary contributors before 1974 and said they should be entitled to limited eligibility indefinitely. This is one of the matters that has been referred to the special committee that I mentioned this morning. This anomaly being specifically raised will be specially considered by the working party of the FUE, the Medical Association and the trade union movement. Many of us can see anomalies in that respect and also as regards manual and non-manual workers. It is no consolation for me to say that this distinction between manual and non-manual workers has obtained for many years. It is one of the anomalies in this scheme and it is also being considered by the working party. It has been examined by the Department and discussed with the CEOs.

Deputy Murphy referred to the inadequacy of payments to homes caring for geriatric cases in the Eastern Health Board areas. I am informed that health board officers met the private voluntary hospitals and the nursing homes association yesterday. I do not yet know the outcome but I shall be sure to look at the report as soon as it is produced or as soon as there is an approach to my Department.

Could the Minister say if an approach was made recently to him, within the past six months, on this matter?

I think I received a deputation some time in July.

Was money made available in the Estimate for increases this year or where would this money come from now?

I am not aware that there is any extra money in the Health Estimate for this particular increase which has been applied for.

Where will the money come from?

The Minister should be allowed to make his speech without interruption. The Chair will allow some relevant questions at the conclusion of the speech.

Deputy Murphy also said he hoped that the first working party meeting would not be simply an inaugural meeting. I do not know what his point is; there must be an inaugural meeting but I want to assure him that this was not intended as a formality. It is the intention to get to work straight away on this difficulty.

Deputy Leonard referred to a delay in orthopaedic treatment especially in the case of hip replacements. There are such delays because new techniques have been developed and many more people are presenting themselves for this operation. Facilities are being improved by the addition of new units and by appointing extra staff. There is an addition to the accommodation being provided at Navan; the unit at Galway is being improved and a new unit for the north west is proposed. In respect of the north west two extra orthopaedic surgeons will be required. That will cut down the waiting list to some extent but will not entirely eliminate it.

Deputy Tunney suggests that extra orthodontists be employed in the public health service. Up to now the health boards gave priority to improving the ordinary dental service. I believe that money will be available this year to recruit orthodontists but they may be difficult to recruit. I can assure the Deputy of my interest in this matter and will certainly do all I can to help to ensure that extra orthodontists will be employed. Whether they can be recruited is another matter. The Deputy made the same point regarding provision of spectacles. He suggested that they be supplied through opticians who would test sight. The use of opticians as against doctors or ophthalmologists in prescribing glasses is being considered but it was deferred last year because of financial considerations.

Many other matters were raised in the debate including one specific and intricate one mentioned by Deputy Dr. Gibbons. If I may be forgiven for not dealing with it now I can promise that I will comment by way of letter to him on the problems that he posed. Finally, I do not think anybody can be dissatisfied with the amount of money being devoted by the Government to the health services this year. There will be a very substantial improvement not alone in the personnel but in the services themselves. Unfortunately, last year it was not possible to do everything all of us would like to have done due to financial considerations. I am satisfied that as far as 1976 was concerned we managed to keep up the standard of health care. This year we can improve it not alone on the non-capital side but also on the capital side.

There will be many hundreds of new jobs which should benefit individuals and the various professions. It pained me last year not to be able to open certain institutions which had been completed in 1976 but now I am in the position where I can not alone open those units but I can also open those that will be completed and ready for occupation in 1977. I should say in case there is any confusion about it that £6.8 million of the £16 million which were allocated for capital purposes have been devoted to new starts on major projects at a cost of £4.6 million. These would be projects at a very advanced stage where tenders had been invited or accepted.

I have also introduced a system where as a result of allocations made to the health boards amounting to £2.2 million the boards may at their discretion engage in work on capital projects that would not cost more than £25,000 and that would be completed this year. It will be within their discretion to decide how that money will be spent. That is estimated to entail 700 new jobs, most of which will be in the building and ancillary industries.

Approximately £2.5 million will be devoted to new health facilities either already completed or due for completion in 1977. It is estimated that 800 additional jobs will be created by the opening of these new facilities. The staff to be employed will include doctors, nurses, para-medics, domestic staff, residential care staff and maintenance staff.

I would like to thank the House for the manner in which they approached this measure and the proposal to establish this select committee. I am confident that 1977 will show a very big increase in the services that were restrained in 1976.

Last year in this same legislation the Minister indicated that an inter-departmental committee had been set up to review the method of financing health and social welfare. Is that committee still there or will they go out of existence because of the Select Committee?

No, they do not go out of existence.

Are they active?

I expect to get their final report towards the end of this year.

Will they be cutting across the Select Committee?

I did not think of that point until the Deputy raised it. Their report will be available to the Select Committee. I do not know if it will be regarded as an internal document but it could be made available.

In the absence of the Select Committee, the inter-departmental committee reviewing the cost of health and social welfare services was a valid enough operation from the Minister's point of view. Now that the Select Committee exist, it seems to me that one or other committee should take over that work.

The inter-departmental committee are at a very advanced stage and for the Select Committee to take over that examination would be superfluous. I assume their report will be available to the Select Committee and the inter-departmental committee will have done a certain amount of work for them.

Was a report from the inter-departmental committee available in the summer of 1976?

No, I do not think so.

Question put.
The Dáil divided: Tá, 65; Níl, 60.

  • Barry, Peter.
  • Barry, Richard.
  • Begley, Michael.
  • Belton, Luke.
  • Belton, Paddy.
  • Bermingham, Joseph.
  • Bruton, John.
  • Burke, Joan T.
  • Burke, Liam.
  • Byrne, Hugh.
  • Clinton, Mark A.
  • Cluskey, Frank.
  • Collins, Edward.
  • Conlan, John F.
  • Coogan, Fintan.
  • Cooney, Patrick M.
  • Corish, Brendan.
  • Cosgrave, Liam.
  • Costello, Declan.
  • Coughlan, Stephen.
  • Crotty, Kieran.
  • Cruise-O'Brien, Conor.
  • Desmond, Barry.
  • Desmond, Eileen.
  • Dockrell, Henry P.
  • Dockrell, Maurice.
  • Donegan, Patrick S.
  • Donnellan, John.
  • Dunne, Thomas.
  • Enright, Thomas.
  • Esmonde, John G.
  • Finn, Martin.
  • Fitzpatrick, Tom (Cavan).
  • Flanagan, Oliver J.
  • Gilhawley, Eugene.
  • Governey, Desmond.
  • Griffin, Brendan.
  • Halligan, Brendan.
  • Harte, Patrick D.
  • Hegarty, Patrick.
  • Hogan O'Higgins, Brigid.
  • Jones, Denis F.
  • Keating, Justin.
  • Kelly, John.
  • Kenny, Enda.
  • Kyne, Thomas A.
  • Lynch, Gerard.
  • McLaughlin, Joseph.
  • Malone, Patrick.
  • Murphy, Michael P.
  • O'Brien, Fergus.
  • O'Donnell, Tom.
  • O'Leary, Michael.
  • O'Sullivan, John L.
  • Pattison, Seamus.
  • Reynolds, Patrick J.
  • Ryan, John J.
  • Ryan, Richie.
  • Spring, Dan.
  • Staunton, Myles.
  • Taylor, Frank.
  • Timmins, Godfrey.
  • Toal, Brendan.
  • Tully, James.
  • White, James.

Níl

  • Allen, Lorcan.
  • Andrews, David.
  • Barrett, Sylvester.
  • Blaney, Neil T.
  • Brady, Philip A.
  • Brennan, Joseph.
  • Breslin, Cormac.
  • Briscoe, Ben.
  • Brosnan, Seán.
  • Crinion, Brendan.
  • Cronin, Jerry.
  • Crowley, Flor.
  • Daly, Brendan.
  • Davern, Noel.
  • de Valera, Vivion.
  • Dowling, Joe.
  • Fahey, Jackie.
  • Farrell, Joseph.
  • Faulkner, Pádraig.
  • Fitzgerald, Gene.
  • Fitzpatrick, Tom (Dublin Central).
  • Gallagher, Denis.
  • Geoghegan-Quinn, Máire.
  • Gibbons, Hugh.
  • Gogan, Richard P.
  • Haughey, Charles.
  • Healy, Augustine A.
  • Hussey, Thomas.
  • Keaveney, Paddy.
  • Kenneally, William.
  • Browne, Seán.
  • Brugha, Ruairí.
  • Burke, Raphael P.
  • Callanan, John.
  • Calleary, Seán.
  • Carter, Frank.
  • Colley, George.
  • Collins, Gerard.
  • Connolly, Gerard.
  • Lalor, Patrick J.
  • Leonard, James.
  • Loughnane, William.
  • McEllistrim, Thomas.
  • MacSharry, Ray.
  • Meaney, Tom.
  • Molloy, Robert.
  • Moore, Seán.
  • Murphy, Ciarán.
  • Noonan, Michael.
  • O'Connor, Timothy.
  • O'Kennedy, Michael.
  • O'Leary, John.
  • O'Malley, Desmond.
  • Power, Patrick.
  • Smith, Patrick.
  • Timmons, Eugene.
  • Tunney, Jim.
  • Walsh, Seán.
  • Wilson, John P.
  • Wyse, Pearse.
Tellers: Tá, Deputies Kelly and B. Desmond; Níl, Deputies Lalor and Browne.
Question declared carried.
Agreed to take remaining Stages today.
Bill put through Committee, received for final consideration and passed.