Health Contributions Bill, 1978: Second Stage (Resumed)

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

(Cavan-Monaghan): On the last occasion I had just risen to speak before I was asked to move the adjournment of the debate. The system of health services and of their funding which this Bill is intended to replace is as follows: holders of medical cards make no contribution to the health service but are entitled to all health services free of charge, while the next category, that known as the middle-income group, make a payment towards the health services under the Health Contributions Act, 1970, as amended. When that Act was introduced the contributions were £7 per year for the self-employed and 15 pence for insured persons. These contributions are now £24 per year and 50p per week respectively. The Minister is replacing that system by what he calls a pay-related system but what he is introducing is not a pay-related system or at least it is a pay-related system but subject to a ceiling and is geared to favour the better-off sections.

Under the present system the holders of medical cards will not be asked to make any contribution towards the health services but will be entitled to all health services free of charge. The next category—those people whose incomes from one source or another do not exceed £5,000 per year or, if they are farmers, although I am not absolutely clear about this from reading the Bill. if their valuations do not exceed £60 per year, will replace what are known as the old middle-income group and their contribution will be 1 per cent of reckonable earnings up to £5,000 which, in effect, means that they will contribute from £1 up to £50 per annum. In return for that payment they will be entitled to free hospital services—hospital beds, hospital maintenance and medical and surgical consultant fees. One might think that is a generous increase in the category of people who will qualify for what was previously available to the middle income group. If we have regard to inflation and the increased costs of hospital services and maintenance, the increase from £3,000 to £5,000 is a small one and does not bring many extra people into this category.

The final category of people consists of those earning more than £5,000 a year or, in the case of farmers, those with a valuation in excess of £60. They will not have to pay any higher contribution than those earning £5,000 a year or those with a valuation of £60. They will qualify, under the Minister's new scheme, for free hospital beds and maintenance but will be required to pay their own consultants' fees. That is the system as I understand it. It is not a pay related system because the pay relating element is chopped off at £5,000. Under the scheme a person with an income of £2,500 will pay £25 per year while a person with an income of £20,000 will pay only £50 per year. The Minister will say in answer to that "Yes, but the people with an income of over £5,000 will have to pay their own consultants' fees". The Minister has killed two birds with the one stone. He has succeeded in pleasing two groups of people and has gone a little of the road with everyone. People who are earning over £5,000 a year have to pay only £50 even if they are earning £20,000 a year. The people earning £2,500 will be conscious of the fact that they will be paying half as much as the people earning perhaps ten times as much as they are. The Minister has the advantage in that he can say to the consultants "Your source of income will not be affected or dried up. You can continue to charge your patients who have an income of over £5,000 a year or those with a valuation of over £60".

It is wrong to call this a pay related scheme. It is a question of going a bit of the way with everybody as was the case with the budget and with the university grants which have been altered today. The fees are going up by 25 per cent and the grants are going up by 20 per cent. This is typical of the approach of the Government to many things since they came into office. They juggle about with figures and systems and produce a hotch-potch which is neither one thing nor the other. This is a classic example of that. When the former Minister for Health introduced the scheme of a free for all health service, he was told in no uncertain way by the consultants that it could not be operated. The major reason given for not operating it was that there would not be enough hospital beds to accommodate the huge influx of people who would come into hospital. Where have the beds come from since? The Minister cannot claim that in his 18 months in office he has produced many new beds. With the best will in the world he could not do that. If people with huge incomes are being asked to pay only £50 a year those who earn £2,500 a year who have not a medical card and who are asked to pay £25 a year are being asked to pay too much if this is regarded as a pay related scheme.

As a rural Deputy from one of the less well off constituencies I am very concerned about medical cards. A great proportion of my time over the last 12 months has been taken up in interviewing people who have complaints about medical cards particularly those whose medical cards have been taken from them and who are frightened of going to the doctor.

Medical cards do not come under the Bill but, as other Deputies have mentioned them, I will allow the Deputy to make a brief statement.

(Cavan-Monaghan): I will not argue with the Chair because that does not lend itself to good debate or pleasantness. The fewer people who have medical cards the more people will be called upon to pay contributions under this measure. I am making the case that people who cannot afford to contribute are being pressurised into making a contribution under the Bill by the manipulation of the medical card system. On these grounds I fail to see any reasonable reason why debate on them is not allowed.

The Fianna Fáil manifesto stated that they would ensure that no person will be denied medical care because of their inability to provide for it out of their own resources. I want to go on record as saying that is exactly and precisely what is happening at the moment. There are many families, and women in particular, who need medical care for blood pressure, depression and arthritis who cannot afford to go to a doctor. On top of that these people will be pushed into the scheme and will be asked to pay I per cent of their income.

Take the example of a county council workman who is earning £51 a week. He is earning £51 a week. He is married. His take home pay is £43 per week. He is living in a new house. I am speaking about an actual case. His rent to the local authority is £6 a week in round figures. That reduces him to £37 a week to support himself and his wife and to provide fuel, food, clothes, and everything else. Under the Minister's system, that man is being asked to pay his own general practitioner and to contribute £20 a year, or whatever it is, towards this scheme. That is an outrageous request. It is outrageous treatment of people with small incomes who need medical attention and cannot afford it.

I compliment the Minister on the public relations service he has at his disposal. In the past week, under big headlines, the newspapers have given the impression that thousands of people would qualify for health cards under the Minister's present scheme. I put down a question to the Minister on 1 November last asking how many cards had been withdrawn in the previous quarter and I got a reply to the effect that the number of cards withdrawn in the July to September quarter 1978 was 24,539. That is a shocking total. Since then I have been trying to find out the number of cards withdrawn in the quarter beginning 1 July 1977. I put down a question to the Minister early in December and the reply was that the information was not readily available but that it would be supplied to me. I did not get the information and about a fortnight ago I wrote to the Minister and asked him for it but I still did not get it. Last Thursday I repeated the question. I have just got the reply but, to be quite candid, I cannot make much of it. The reply states: "The information sought is given in the attached table". To begin with there is no attached table. It goes on:

The grand total shows a reduction from the figure given in reply to the Deputy's question on 1 November 1978. This is due to subsequent modification of the earlier figures received from the Southern Health Board. These figures, of course, take no account of new cards issued and over the same period the total number of medical cards increased by just over 12,000.

I do not know what that means.

The fact is that health cards are being cancelled or withdrawn all over the country. The ceiling for a health card for a man and woman is about £40. I put it to the Minister that he is being unreasonable, or his health boards are being unreasonable, in expecting a married man employed by a county council with a take-home pay of £43 after he pays his income tax and his superannuation contributions to pay £6 rent and to pay for food, heating, clothing, transport and everything else and pay a doctor £3 or £4 a visit to himself or his wife and to pay for drugs up to £5 a month. It is being harsh and it certainly does not live up to the Fianna Fáil manifesto which said nobody would be denied medical care because of their inability to provide for it out of their own resources. These people are now being shoved out of the medical card system and into the net in which they will be called upon to pay 1 per cent of their earnings.

Some people might say if the husband stopped drinking pints or smoking it might be good for him, but human nature is human nature. In the case I am talking about the unfortunate woman has to take a bus and travel six or seven miles to Clones and pay the doctor £3 or £4. This is not an isolated case. The wage of a county council labourer is fairly typical of incomes in rural Ireland. Food subsidies have just been removed and the cost of living has just gone up. The £51 this man gets from the county council does not go as far and leaves him with a smaller disposable income. I am afraid in the long run this will increase the cost of health rather than reduce it.

Whether the Minister knows it and whether he is responsible for it, since he took office we have gone back to the stage where the social welfare officer counted the hens and almost counted the eggs so far as small farmers are concerned. There are not as many hens and therefore there are fewer eggs, but these officers are going through the incomes of small farmers with a fine comb. Studies and surveys carried out show that the vast majority of farmers are living on less than £40 a week, less than £2,000 a year. Those people should not be asked to pay their general practitioners.

I remember when the late lamented Donogh O'Malley was Minister for Health. He was told one day by way of a supplementary question that county managers, as they then were, were denying health cards to people with old age pensions. His reply was that anybody who would deny a health card to an old age pensioner was not fit for his job. A circular went out and from that day until recently anybody who had an old age pension qualified for a health card. I am sorry for labouring this but with all due respect I think it is relevant to where these contributions are to come from.

I am giving the Deputy a fair amount of latitude.

(Cavan-Monaghan): The only major point I want to make is: who is liable for them? Human nature being what it is, people usually put off going to the doctor until they have to. They certainly put off going to the doctor when they cannot afford it. In this case in my constituency the patient goes to the doctor in Clones. The last day she was there the doctor informed her that he was charging her a nominal sum only because she could not afford to pay.

There is no point in the Minister telling me, as he is technically entitled to, that there is a hardship clause and that the last word lies with the chief executive of the health board, who will administer justice. As far as I can see, there are blanket guidelines of £26 for a person living alone and £40 for a married couple with allowances for children. These guidelines are being operated in the area with which I am most familiar and the hardship clause does not seem to exist. Small farmers and people who live on small incomes in towns are being vicitimised. There should be a flexible rule. A person who requires a great deal of medical attention should be given a health card.

I would ask the Deputy to get back to the Bill. We cannot have a debate on health cards. I have given the Deputy an opportunity to raise the matter but he is going to town on it.

(Cavan-Monaghan): A few days ago I listened to a learned medical man talking about everything under the sun. The only difference between the two of us is that he was referring to technical matters which the Chair did not understand.

I would not admit for a moment that I did not understand what Deputy Dr. O'Connell was at. The Chair understands what Deputy Fitzpatrick is at too.

(Cavan-Monaghan): The Chair will find that Deputy Fitzpatrick is nearer the earth than some people.

With sincerity I say to the Minister that many people in rural areas—small farmers and people living in terraces in towns—are not able to pay medical fees and should not be asked to pay them. They should get the Fianna Fáil manifesto, send it to the Minister and say "I am in that category. I am not able to pay and should not be asked to pay."

I have done by best to discharge a serious obligation. Nobody understands this problem better than the rural TD who is holding clinics in small towns, as I am. The people are not coming to me for fun or to make a nuisance of themselves. In the past six months 75 per cent of my time has been taken up in talking about health problems.

I should like the Minister to tell me how the farmers contribution will be calculated.

The percentage will apply.

(Cavan-Monaghan): On a per £ valuation?

The £5,000, or whatever the upper limit is, will be used with the £60 valuation, and down along the line.

(Cavan-Monaghan): I understand.

I should like to refer to section 14. The information which the Revenue Commissioners receive from inspectors of taxes is being treated less confidentially than heretofore. Since the change of Government this is the third Bill in which the Revenue Commissioners have been given authority to disclose to other Departments information which they have received from taxpayers. The Agricultural Rates (Relief) Bill is one of them and the Bill in connection with grants under the Housing Acts is another. I deplore this departure which must have been a calculated decision taken at Government level. Section 14 reads:

So far as may be necessary for the proper administration of the Act of 1970 and of this Act, information regarding health contributions and the reckonable earnings, reckonable emoluments and reckonable income of individuals in respect of whom health contributions are payable which is obtained by the Revenue Commissioners in connection with the collection of income tax or health contributions may be supplied by them to the Minister or to a health board.

I object to that arrangement. Information given to the Revenue Commissioners has always been treated in a confidential manner.

Some of Deputy Richie Ryan's legislation tore a hole in that.

(Cavan-Monaghan): Deputy Richie Ryan is blamed for many things. I was listening to the “Late Late Show” one night and heard a gentleman saying “We all know that Richie Ryan put the income tax up to 80p in the £ and George Colley brought it down to 60p”. I could not sit and listen to that. When I phoned the studio I got a begrudging acknowledgement that the reverse was the case.

I am afraid the Chair cannot listen to it either. It has nothing to do with this Bill.

(Cavan-Monaghan): It has. Deputy Colley increased it to 80p in the £ and Deputy Ryan reduced it to 60p.

I object to the invasion of the privacy of the citizen. This is a pay-related scheme with a ceiling. It has been drafted in favour of the better-off members of our society. I would ask the Minister to look at the guidelines and to consider that these people are expected to keep homes and families on an amount of money which some people pay for one dinner. The Minister should look at section 14 and try to see if there is any way to stop the passing of confidential information from Department to Department.

I should begin to reply by saying that I appreciate the generally constructive and helpful attitude of most Deputies towards this Bill. I do not suppose that I can legitimately complain if a number of Deputies availed of the debate on this measure to range over the health services in a very broad way. It indicates that individual Members are on the one hand very knowledgeable about the health services, their scope and details of their administration and also that they are concerned that our health services should be as near perfection as we can make them and that they should be continually pressing for improvement in one area or another. A number of very good points were made in the discussion. The Chair was reasonably lenient in the scope allowed to Deputies and I doubt that I will be permitted to reply in detail to various points made.

The first issue which arose in the minds of most Deputies was the income ceiling or limit which will be as I have already indicated on a number of occasions, £5,000 or thereabouts. We must always keep in mind here that it is essential for efficient operation of this new service that the same maxima will be applied on both the social welfare side and the health side. There would be almost insurmountable difficulties and complications if we did not have the same ceiling for both. On the social welfare side the ceiling is fixed at approximately one and a half times average industrial earnings. The reason for that formula being used is to ensure that the overwhelming majority of wage and salary earners are included in the scope of social insurance. That more or less decides the ceiling for it. I have already pointed out also in connection with the social welfare legislation and with this legislation that the final figure will be determined before 1 April and will be settled and brought into operation by regulation.

So far as the health side is concerned it is important to remember that the ceiling and indeed the income generally which will be used as a basis for qualification will be the income for the preceding year. In other words, the income limit for eligibility purposes in the year commencing 1 April 1979 will be the income for the preceding year, the income earned between April 1978 and April 1979. That will have the effect of some easement in so far as people at the upper limit are concerned. A decision regarding their eligibility will always be based on their income in the preceding year. The situation in regard to manual workers with incomes in excess of £5,000 has been stressed on a number of occasions during the debate but the only point that can be made in the case of this category is that they now become eligible to pay for their consultant services.

Deputies know the history of this matter and I think any fair-minded Deputy would have to accept that what we are doing now is a very considerable advance on the complicated anomalous situation which prevailed up to now where you had a limit of £3,000 and superimposed on it a situation in regard to manual and non-manual workers. The whole thing had got into a practically unintelligible state in recent years. These proposals bring clarity and certainty into the situation. In future there will be clear-cut categories of persons entitled to certain services. That is a distinct advantage and a definite advance.

The higher paid workers—and I think I am entitled to call anybody earning more than £5,000 a year a higher paid worker—will not be left unaided as regards these consultant services. With the full co-operation of the Voluntary Health Insurance Board we will be able to provide a very satisfactory method whereby the people earning over £5,000 a year will be able to provide against any liability they may incur regarding consultant services.

Deputy Boland asked me if the new package which the VHI Board were bringing in would be open to the general public and I am very glad to say that it will. I speak about it principally in connection with manual workers earning over £5,000 a year because it is of particular interest to them. But the situation will apply which has always applied, namely, that the package will be open to every member of the general public. The VHI will shortly be publicising their new scheme and they will now be providing the following benefits: maternity benefit to cover a range of payments for consultancy fees; relaxation of the existing rules governing payments where miscarriages are involved; they will provide for special nursing; there will be relaxation of existing rules governing payment in respect of day surgery and the introduction of a new benefit dealing with cases requiring convalescent care. In addition, for a limited period the existing entry restrictions regarding previous medical history will be lifted. There will be no waiting period in regard to eligibility for benefit and no entry age limit, which is very important. The age loading for subscribers over 60 will be discontinued. Finally, and perhaps equally important, is the fact that anybody who wishes will be able to pay premiums on an instalment basis.

I strongly urge that everybody in employment, certainly in the upper regions of income, should without delay get in touch with the VHI and study the package which will now become available. I have been urging the trade unions to draw the attention of their members, particularly those with over £5,000 a year, to this new package.

I have indicated to them that the VHI board will be prepared to organise discussions and seminars, and I believe that if the wives of most of the higher paid workers were to become fully aware of the package the VHI are now offering we would have a major influx of higher paid workers into the VHI, which is what we are aiming at. It would be a very attractive package. It would provide considerable benefits and I would hope that it will be very widely availed of by the trade union movement and by salary wage earners generally. The package has not been fully publicised yet, but I believe that it will be possible for families to provide against the cost of consultancy services for as little as £11 per annum for each adult and less than £4 per annum for each child. If you take those figures and allow for the fact that the full premium payable to the VHI board is available for income tax purposes, this is a bargain which is being offered. I repeat that I asked the trade union leadership in particular to bring these services to the attention of their members. I urge strongly that they would avail of them and get into the VHI. Any member of the VHI will agree with me and confirm that it is a most satisfactory organisation to belong to. It gives a very efficient service. When you submit your claim it is dealt with in a most expeditious manner and with the minimum of bureaucratic inquiry.

Some doubt was expressed here about the possibility that difficulties might arise in the allocation of hospital beds and that there might be some question that fee-paying patients would procure an advantage over non-fee-paying patients. I assure the House that any such fears are groundless. These matters have been discussed with the medical organisations and the health board managements, and the House can be assured that there will be no change whatever in the existing situation. Beds will be allocated in the public wards entirely on the basis of medical needs. This will be the governing criteria and it will be impressed on hospital managements, health boards and voluntary hospitals that this is to be the situation. Not indeed that anybody need fear that there will be any question in any of our hospitals of anything otherwise prevailing. The guiding principle will be that patients will be admitted to hospital, as they have always been admitted to our public wards, on the basis of medical priority.

Deputy Boland queried the figures of yield from these new health contributions, and perhaps I unwittingly contributed to some misunderstanding here. It is calculated at 1 per cent at existing rates and will bring in about £30 million in a full year. In 1979 the 1 per cent will not be operating for a full year, but only from April to December. Therefore, at the £5,000 a year ceiling, 1 per cent in that April to December would bring in £22.5 million. To that must be added what the existing flat rate contributions will bring in between January and March, and that will be a figure of £4.1 million. Therefore, the total estimated income for 1979 will be £26.6 million.

Some Members have expressed concern about the situation in regard to farmers. The new situation will be that farmers will pay health contributions the same as any other section of the community, on a pay-related basis. The upper ceiling will be related to a £60 valuation and valuations under £60 will be calculatedpro rata, and the 1 per cent will be a figure so calculated. There will be improved machinery for the collection of the health contributions from the farming community because the existing situation is not entirely satisfactory. The health board records indicate that the average collection rate is about 70 per cent, though the figure may be a little higher than that. Many persons have been billed and therefore contribute to the overall total, though because they are medical card holders they would be entitled to exemption. The new system will apply fully to the farming community and every effort will be made to perfect the system of collection.

Some Deputies, in particular Deputy O'Connell, referred to the question of drugs. This is a very important element of the whole administration of the health services. First of all, Deputies will have seen that I was at last able to promulgate the necessary regulations to give effect to the Misuse of Drugs Act last week. Unfortunately, these regulations were a long time in course of preparation. They are very complicated and complex, and they involve long, arduous and tedious discussions with many interests, all of whom had to be consulted and whose advice had to be obtained. Now they have been promulgated and the Misuse of Drugs Act is now fully operative, and we hope that it will be effective in controlling abuse of dangerous drugs which exists in our community.

Apart, from dangerous drugs, there are the normal, ordinary drugs and there is a fairly widespread agreement that we are as a community far too dependent on drugs and medicines. The marvellous advances that have been made in the pharmaceutical industry in recent times are, of course, a boon to mankind. They now enable all sorts of illnesses and diseases to be cured and cleared up which previously were, if not incurable, very nearly so. There has undoubtedly been a marvellous improvement in general medicine as a result of discoveries of the pharmaceutical industry. However, that very improvement has brought its own danger in its train. Some people are inclined to think that there is no illness, disease or defect that cannot be cured if one has access to the right drugs. Of course we know that that is not so. Therefore it is important to maintain a balance in our approach to drugs and medicine, to realise their value and at the same time realise their limitations.

In general, the GMS relies to too great an extent on drugs and medicines. We are making a consistent effort to curtail the excessive use of drugs and medicines. At the same time we do not want to interfere with the legitimate interests of the patient, or the doctor's right to prescribe what he in his discretion considers to be appropriate. With the full co-operation of the medical profession we are introducing a number of measures which will reduce the cost of drugs in the GMS and will help to reduce the dependence of the population in general on drugs and medicines.

For the information of the House, a very important seminar will take place on Friday of this week. It is being organised by the Irish Medical Association in co-operation with my Department and the Health Education Bureau and it will be entitled "The Alternative to Drugs". It will seek to get the message across that when one visits a doctor it is not always necessary to come away with a prescription for a drug or medicine. Very often a doctor can meet the needs of a situation in a different way and the patient should not feel cheated or deprived if having visited a doctor he does not emerge with a prescription to be brought to the nearest chemist. I hope this seminar will perform a useful service in this area. Side by side with the organising of that seminar, the Health Education Bureau will initiate a campaign along the same lines, to encourage a more conservative approach to medicines, a campaign which will be designed to get the message across to the general public that drugs and medicines have their legitimate uses but that it is socially wrong and bad medicine to rely too much on them.

One criticism made by Deputy O'Connell is entirely without foundation and if he thinks about it he will realise that it is not a valid criticism. Deputy O'Connell said that by bringing in this legislation we are establishing a massive bureaucracy. We are doing exactly the opposite. The combined effect of this proposal for a new system of collection of health contributions and the new pay-related system which will apply in social welfare, will be a very considerable reduction in administration and bureaucracy. From now on there will be only one clear-cut specific percentage deduction, made by the employer, and employers will know exactly who they must make the deduction from, and overall there should be a much tidier administrative system. That is certainly one of the objectives. Anyone who studies the thing in detail will realise that there should be very considerable savings all round in administrative costs when these new systems are introduced.

Deputies are aware of, and most Deputies will support, my emphasis on health education and preventive medicine. Here, as in most EEC countries, it is recognised that this is ultimately the only way to bring the cost of health services under control. It is only by persuading more and more people to take care of their health and to avoid the sort of life style that creates ill-health, that we can meet the very heavy cost of our health services in the future without placing an undue and intolerable burden on the taxpayer. In relation to health education we are continuing our efforts in regard to smoking, and Ash Wednesday this year will be proclaimed a national "no smoking" day. With the assistance of the Junior Chambers of Commerce throughout the country we hope to have a major "no smoking" campaign throughout the country on Ash Wednesday. More details of that will be announced in due course but that is one of the efforts we have in mind for the immediate future in our campaign against cigarette smoking.

Increasing attention has been directed to the problem of alcoholism. There was an interesting seminar recently which most Deputies will have read about where some of our experts gave their views about the incidence of alcoholism and the dangers involved in excessive drinking. A different situation prevails here than that in regard to smoking and it requires a different approach. We have to develop our services in relation to alcoholism. We have, I regret to say, a fairly high number of people who suffer from the disease of alcoholism and we must increase and improve our services for this very vulnerable section of the community. We must also give much greater attention to prevention in this area. Nobody would suggest that we embark on totally restrictive campaigns. We must curtail and limit the abuse of alcohol, to try to eliminate excessive drinking and if at all possible encourage widespread support for the concept of moderate drinking. Most people would agree that alcohol is one of the benefits available to mankind, but it is only a benefit if it is sensibly and moderately used. That must be the keynote of our approach to alcoholism and excessive drinking.

Many other issues would naturally arise in the course of a debate of this sort and one is tempted to go on and turn this debate more or less into a general resume of the activities of the Department of Health. However, I intend to resist that temptation. I would hope that I have dealt to their satisfaction with most of the points raised by Deputies.

Before I conclude, I wish to comment on one point raised during the course of the debate. This was the suggestion that we should have health programmes on radio and television. I am glad to be able to inform the House that we have made and are making considerable progress in that regard. It is clear to most Deputies that the power of television in this area is enormous. It is a very effective medium for getting across all sorts of messages. The RTE Authority and the Department of Health have a mutual interest in this field. People are interested in their health and, therefore, good health programmes could be good television. I think that concept is accepted in RTE and we have had many useful and helpful discussions involving the Department of Health and the Health Education Bureau. In the months ahead we can expect quite a number of useful and beneficial programmes in the field of health on radio and television. I am glad to be able to mention that to Deputies and also to say that the attitude within RTE is entirely helpful. There are many difficulties involved in this, but in regard to attitude I may say that there is nothing but helpful co-operation forthcoming. A great deal can be done and enormous benefits can ensue from co-operation between the Health Education Bureau and the RTE Authority.

It was I who raised a question about the cost of the Refund of Drugs Scheme. I asked the Minister to give the House any figures which may be available in regard to the average cost of processing a claim for refund of drugs.

I recall the Deputy mentioned that. The cost of the scheme in 1978 was about £2.1 million. From 1 April it will be extended to the community as a whole. It is not a very expensive scheme from the point of view of administration. It is regarded within the Department as a scheme which gives very good value from the administrative point of view.

The complaint about the scheme concerns the delays which occur in making the refunds and we must give attention to that aspect. I met a deputation yesterday representing suffers from asthma. They are very appreciative of the refund at present given to people with limited eligibility and the fact that this refund will now be available to all members of their society, to all asthmatic sufferers. They say that the benefits is seriously impaired by the delay in the making of the refunds and I undertook to consider that aspect. Deputy Boland need not have any fears about wasteful or excessive administration costs. The scheme can be very simply administered and will give good value.

Question put and agreed to.
Committee Stage ordered for Wednesday, 21 February 1979.