asked the Minister for Health if the statement in paragraph 19 of the NESC report on major issues in health policy that the extension of the present limited eligibility scheme to the entire population is already the stated aim of the Government represents the policy of the present Government.
Ceisteanna—Questions. Oral Answers. - NESC Report.
18.
The policy of the present Government, which will be given effect to in April 1979, is to extend to the entire population the following services: (a) the full range of hospital in-patient services at public ward level, free of charge except for the charges to be made by hospital consultants; (b) subsidies towards the cost of private or semiprivate accommodation; (c) specialist diagnostic and treatment services on an out-patient basis in public hospitals, subject to the patients being responsible for payments to the consultants concerned; (d) refund of part of the cost of prescribed medicines.
Is not this a regression from the policy of the previous Government who, apparently, envisaged an extension of the general medical service to all members of the population?
I do not think the Deputy can expect any member of the general public to agree that this very considerable extension of the services which is coming into operation in April next is in any way a retrogression from the appalling and abysmal situation that prevailed during the term of office of my predecessor.
That is not the information I asked for. I asked the Minister whether his policy whereby he intends providing a limited service—not a free medical practitioner service—is a regression from the policy as stated in the ESRI report to which I am referring and which presumably was the policy of the previous Government since clearly it is not the policy of this Government.
It may have been an aspiration on the part of the previous Government but so far as they were concerned there was neither an attempt nor a possibility of implementing anything of the kind.
That was because the scheme was sabotaged.
Every attempt was made to implement it.
When I came into office I found generally a totally inadequate health service. The only real contribution to the situation so far as the previous Government were concerned——
Fianna Fáil have been in office for most of the lifetime of this State.
——was a savage and unprecedented cutback in the health services in 1976, the effects of which we are only now beginning to recover from.
(Cavan-Monaghan): Nonsense. There is a cutback in medical cards now the like of which was never known before.
It ill behoves members of Fine Gael or Labour to criticise any aspect of the health services.
The Minister is being propagandist. In what areas were there cutbacks?
The Coalition Government actually stooped to the level of cutting back in the area of meals on wheels.
Would the Minister agree that, although he may wish to extend the services, the Minister for Finance will not sanction the expenditure?
(Cavan-Monaghan): There is an unprecedented cutback in the number of medical cards.
The number is increasing.
(Cavan-Monaghan): Tell that to the marines.
The number increased during the term of office of Deputy Corish, too.
It is Lloyd George medicine.
(Interruptions.)
Order.
Is it the intention to extend eligibility for the medical card beyond the present 38 per cent? An extension would be in line with statements made by the Minister, who has said that the percentage would be increased to 66.
The guidelines are laid down from time to time and so far as I know they are adhered to by the CEOs. There has been an increase in recent months in the number of medical cards being issued.
That is not the information I asked for.
I am dealing with the question on the Order Paper.
Is it the intention to extend the medical card service beyond the present level of 38 per cent of the population?
That question does not arise. We must move on to the next question.
Is the Minister prepared to fulfil the promise made by him in this regard?
Obviously, Opposition Deputies are very unhappy that there is coming into operation a major improvement in our health services, an improvement which they were totally incapable of introducing.
(Cavan-Monaghan): We shall have to wait and see.
I have called the next question.
The Minister has not answered my question.
I have answered the question on the Order Paper.
I asked whether it is the intention to extend the medical card service to a greater proportion of the population. I am not endeavouring either to badger or to embarrass the Minister, but I would like an answer.
I have answered and I refuse to reply three or four times to a question.
There was no reference to medical cards in Question No. 18. We must move on to the next question.
May I take it then that the Minister is not replying to my question?
I have replied to it.
19.
asked the Minister for Health if he accepts the policy declaration in paragraph five of the NESC report on major issues in health policy that international policy has been towards access free of charge at the point of use for all citizens regardless of income or class.
I am not aware of the grounds for the statement quoted by the Deputy. The proposals, which I have announced recently, extend free hospital maintenance to the entire population. I consider however that some equitable balance must be maintained between services which are available without charge to everybody and those for which payment must be made at the point of use by some sections of the community. In adopting this approach, I believe that I am not at variance with advanced thinking in other countries on this subject.
Is it not the position that the report to which I have referred points out, at page 76, that the medical profession have begun already to press for universal compulsory insurance and that they are likely to intensify their insistence not only because this trend is observable already on a worldwide scale but for other reasons also which concern emigration? The reference was to the Irish medical profession. Therefore, what the Minister is proposing is a regression from what is observable in most advanced western European countries.
(Cavan-Monaghan): Arising from the Minister's statement that hospital treatment in public wards will be available for all, is he satisfied that there are now sufficient hospital beds to provide this service?
I will have to answer that question under a number of headings. First, the number of beds, as the Deputy probably knows, is being increased very substantially all the time. We have a major building programme of beds for acute general hospital services under way. Secondly, in so far as there may in any particular area be a shortage of beds, it will be a matter for the medical staff of the hospital to decide their priorities. The extension of cover for hospital services will not affect that priority decision-making of the hospital in any way. Finally, it will be part of the new order of things to encourage more people who can afford to do so to go to private accommodation and thereby relieve the public ward situation.
(Cavan-Monaghan): If that is so, would the Minister agree that the excuse of the consultants when they refused to operate the scheme suggested by his predecessor that there were not sufficient beds, was not a valid excuse and was simply a guise to ensure they would get more fees?
I do not know anything about that.
Arising from the Minister's reply that he would encourage people to go to private doctors——
Private accommodation.
——Private accommodation and private doctors presumably——
More money for the consultants.
——is it not a fact that this report to which we have referred makes the very valid point that direct charges in medicine tend to distribute medical services towards the relatively rich? Is not that what he has in mind? Is not that the only class he is really concerned with?
I do not subscribe to that statement.
We are getting into the realm of argument and I do not propose permitting it to continue. I am calling Question No. 20.
That is a fair question. It runs through all the services, whether education, housing, health or anything else.
The Deputy will please refrain from argument at Question Time.
I would like to suggest to the House that we will have an opportunity of debating these matters very fully when the appropriate legislation comes before the House this term.
It has not been published and we are waiting for it.
It will be published this term, in plenty of time for it coming into operation next April. The Deputy need not worry about that. The proposals which I am bringing in next April, having regard to the resources available to us, I think represent the best possible approach to providing reasonable medical and health services for our entire population at this time.
The worst in Europe.
In no way is it the worst in Europe.
One would have to travel very far——
Question No. 20.
The Deputy should visit some European countries and see what the actual position there is.
What would the Minister know about public wards?
I have often been in public wards. I have probably been in more public wards in my time than the Deputy.
But not in public beds.