Vol. 317 No. 9
I move:
That a supplementary sum not exceeding £72,480,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 1979, for the salaries and expenses of the Office of the Minister for Health (including Oifig an Ard-Chláraitheora), and certain services administered by that Office, including grants to Health Boards, miscellaneous grants, and certain grants-in-aid.
We have had many debates on Health during the year but it is unfortunate that we do not have more time to go into this in a little more detail. I hope the Minister, Deputy Woods, will take note of what has been said and give more attention to the Department of Social Welfare but in so doing I hope he will not neglect the Department of Health.
There has been great concern at the withdrawal of medical cards. I do not know if the Taoiseach has the answer to that, but I am sure it has come to his attention before now, as it came to the attention of most public representatives. If this cutting back has been done for the same reason the Taoiseach gave for the Southern Health Board not having the free fuel scheme extended to their area, I do not know. There has been a big cutback in medical cards. In cases where they have been withdrawn, they have been subsequently restored following representations by me and by other public representatives. Why do people have to suffer the withdrawal of medical cards when it is obvious that there is no need for it? Their income and qualifications are such to qualify them for a medical card. I am sure that in many cases people do not bother going to a public representative or are not aware that by doing so something could be done for them. They accept the withdrawal of the card and do not have the benefit of it despite the fact that they are qualified for it.
I hope the Minister will give some attention to the building of a new hospital at Tallaght. This is a pet subject of mine, but it is not so many years since I raised this matter and was told we would not be getting a hospital at Tallaght. I did not accept that and continued to put down motions at local authority level and make representations regarding the need for a hospital to serve the south city and county area. I am glad the decision was made to build a hospital at Tallaght. However, there is some great delay. The Taoiseach got some publicity during his term as Minister for Health. People in the area were very hopeful. It is important when one is building a new town to have Government Departments or offices of some importance in it to give it a lift so that it can play its rightful part. I look forward to the new hospital at Tallaght to give it that lift. Something has gone wrong. The site is there and everything seems to be in order, but the Taoiseach chose perhaps to give the hospital at Beaumont preference. I am not faulting him for that. There was a need for that hospital. If there is a dragging of feet with regard to the new hospital at Tallaght we should know about it.
I deplore the absence of a cardiac ambulance service in Dublin. I am sure, although I have not checked, that we must be the only city of this size without such a service. When we think people are likely to get heart attacks—and I am sure they are having them every day of the week, not to talk about the last week——
Last week was an exceptional week.
The House will get a heart attack in a few minutes when I put the Estimates.
I should like to hear from the Minister what progress has been made with regard to the provision of a proper cardiac ambulance service for the city of Dublin. I know it is envisaged that there will be three or four units. When I inquire about the matter at the health board I am told the reason the service has not been provided is because of the time needed to train staff. I have been hearing that for too long. By now we should have trained enough staff to service cardiac ambulances for the entire EEC. I wish the Minister well in his Department, whether his stay there be long or short.
The Chair understands that there is agreement to take the Appropriations Bill at 7.40 p.m. That leaves very little time for the rest of the Estimates.
This is a very substantial sum within a few weeks of the end of the financial year. I wonder if it is being put in in an effort to lighten the load on next year's budget? As was the case with regard to social welfare, unless the money has been spent already I cannot see how it could be spent before 31 December.
I am glad to see the Minister for Health and Social Welfare present in the House. I have wished him well in his job already. He must have a look at the way in which the new scheme of payments for health is operating. An employed person is having a deduction of 1 per cent from his wages. If a person has a small amount of land or if he is rated for it, he is notified by the local authority of a sum he must pay. That is fair enough in the case of an employed person who has some land but at the other end of the scale old age pensioners are getting bills that in some cases are more than their weekly pensions. Something is seriously wrong with the system.
My other question is with regard to people who go to hospital. Up to now, except in some cases, when insured people went to hospital they knew they would be covered for general medical payments and that included consultants' fees. Now very many people are excluded for one reason or another. I know of people who were advised by their doctors to go to hospital but who were very worried because they felt they could not pay the bills. More effort should be made to explain the position to people. I know that public representatives from both sides of the House are being approached by people who want to know their rights. While the intention behind the scheme was probably a good one, we have reached the stage now where it is working in a way that was not intended. The new Minister for Health should ensure that this matter is explained as fully as possible.
Subhead G.1 deals with grants to health boards in respect of net expenditure excluding expenditure on cash allowances and cash grants and payments to the general medical services. There is also provision for an additional sum required for grants to health boards. The amount in question is £41,975,000. Subhead G.4 deals with grants on behalf of health boards to certain other bodies. There is provision for an additional sum required for grants on behalf of health boards to hospitals and homes other than those administered by health boards. The sum in this case is £22,128,000.
Throughout the country most of the hospitals are full to the doors. Some years ago I was a trade union official organising staff in a number of hospitals. I remember on one occasion the staff had to leave a union meeting because the matron insisted they should go in to say the rosary. I asked if she wanted them to pray every night that the hospital would be kept full and would pay its way. Now, they do not have to pray. The hospitals are full and many people have no hope of getting admission. Many people require what they consider to be fairly serious operations but their doctors tell them they can do nothing about it, that they will have to wait until a bed is available. The new Minister must consider this matter. There must be a better way of dealing with the problem.
There is another problem that must be dealt with from a Christian point of view, apart from anything else. In some cases when an old person goes to a hospital in a seriously ill condition and where the illness develops, the hospital authorities send for the relatives to tell them that they can do nothing for the patient and that he or she must be taken home. I heard of a case recently where a patient was being moved from one hospital to another hospital where there was a more Christian outlook but the patient died on the way. It is very unfair to treat old people in this way.
Another problem is developing again, one that Deputy McEntee when he was Minister for Health dealt with during his term of office. If a person dies on the road, whether as a result of a road accident, a heart attack or whatever it might be, it is unchristian not to allow an ambulance to take that person to hospital or to the morgue. If a non-medical person rings a hospital to notify them that somebody has died and asks for an ambulance, the reply is that if the patient is dead an ambulance cannot be sent. The new Minister should give his attention to that matter.
The Chair will have to put the remainder of the Estimates at 7.35 p.m.
I wish to draw the attention of the new Minister to the system operating with regard to medical cards. When the Taoiseach was Minister for Social Welfare, certain guidelines were set last January by officers of the health boards. In my local health committee, I proposed that they be reconsidered. In the budget food subsidies were withdrawn. I understand that a meeting is being held today to revise the guidelines. At the moment the figure set is £37.50 for a married man and his wife. In the name of God I ask the Minister to have the guideline revised more regularly than once a year. People who are on the borderline are being refused by health boards and are being held to the limits.
I congratulate the Minister on his appointment. I feel so strongly about this matter that I had to bring to the attention of the Minister that a man and woman living together on £37.50 a week are being asked to do without a medical card.
In relation to the point raised by Deputy Bermingham, the levels are due to be revised in January on the basis of the CPI of mid-November.
It will be next January before they are raised again.
I am just giving the Deputy the factual situation. In any event, I have noted the Deputy's point.
Deputy Tully raised the question of duplication of payment of health contributions for part-time farmers. There is no double liability. If a person has paid the maximum contribution of £55 through PAYE and informs the health board of this, he need not pay a contribution as a farmer to the board.
He would not have to do that until the end of the year.
We will note the Deputy's point.
A number of other questions were raised of which I am aware at this stage. I should like to inform the House that the Taoiseach, who was responsible for these supplementaries, felt that he would be able to give more information at this time and made himself available for that reason.
In relation to the number of medical cards withdrawn, a reply in relation to this matter was given to Deputy Donnellan today. The reply was that the number of medical cards withdrawn or cancelled between 1 January and 30 September 1979, the latest date for which figures are available, was 57,437. During the same period, however, there was a net increase of 4,824 in the number with medical cards. The total number of persons covered by the service increased by 8,779.
Deputy Tully referred to pensioners. He referred to their liability being as big as their week's wages. I spend a good deal of time working with old folk and I would be concerned about that sort of incidence. I would like to ensure that the administrative systems did not allow this to happen. I appreciate that it is difficult in an administrative sense and I would like to find measures which would overcome such practical and human difficulties. I also accept the point he made in relation to people being ill, particularly where they suffer from heart attacks. If there are charges due by them there should be a human way of dealing with the situation because it could cause great stress. The question of elderly people having to go home from hospital is related to the kinds of services available, not only in association with the homes but in communities generally. There has been a considerable improvement in recent years in the provision of homes for elderly persons. I would also be keen to pursue that matter.
In relation to Tallaght hospital, the site has been acquired, the board has been agreed though not set up as yet, and a delay in the programme is not expected.
The remaining Estimates will be taken without debate.
