In speaking earlier I made the point that the few words spoken by the Minister in moving this variation to the regulations did not illustrate the present situation. The Minister suggested that he was increasing the income limit for persons with full eligibility for hospital and certain health services and this is not, in fact, the situation.
The existing regulations made this time last year and discussed here on 27 March 1979 provided for the hospitalisation insurance scheme to be made available in full to all people with incomes under £5,500. The then Minister was pressed very firmly to increase that figure but adamantly refused to do so, although at the same time the other arm of Government, the Minister for Economic Planning and Development and the Taoiseach, separately negotiated and successfully concluded the national understanding, under which the income limit for full eligibility was increased to £7,000.
The text of the national understanding stated that the Government had authorised the Minister for Health to make arrangements for an upward revision of the health eligibility limit from £5,500 to £7,000. At this stage it is surmise but apparently they had not seen fit to have any great prior consultation with the then Minister for Health, who appeared to be strangely unaware of the increase in the income limit and initially pleaded inability to introduce the increase. Eventually, under pressure to honour the terms of the national understanding, he introduced what he described as an interim scheme. Under the terms of that interim scheme, all those earning under £7,000—the additional people being those earning between £5,500 and £7,000—were from 25 July last brought into the full hospitalisation eligibility scheme.
They were told they could obtain a refund of any money outlayed from the Voluntary Health Insurance Board. This was a rather strange situation, especially in view of the fact that even persons who were not subscribers to the VHI were instructed to seek refunds from that board. In reply to a question on 23 October 1979 the then Minister for Health stated:
The expenses involved, and for which a payment may be claimed, are:
1. Portion of the premium paid to the Voluntary Health Insurance Board for the board's public ward scheme.
2. Hospital consultants' bills, to persons without voluntary health insurance for services received as in-patients in public wards.
3. Hospital consultants' bills for services received as out-patients in public clinics.
4. General practitioner bills for maternity services.
I also understand that cover was to be provided for people in the £5,500 to £7,000 income category in respect of infant welfare services in cases where a child was referred from the clinics for specialist attention. Had they been within the income limits the parents would have been covered for that specialist treatment of the infant. They had been excluded under the terms of the scheme announced in the Dáil on 27 March and the regulations signed by Deputy Haughey, the then Minister for Health. On foot of the terms of the national understanding they were re-included. This involved the health boards in the area of confusion which had been created by mid-summer by the differing levels and standards of negotiation conducted by different Ministers, all members of the same Cabinet. At this stage I myself found difficulty in establishing the situation but apparently the health boards were obliged to bear the cost of the specialist services provided for children referred under the infant welfare scheme in respect of people with incomes between £5,500 and £7,000. I may well be wrong in that and if so I would not be at all surprised.
If confusion exists in my mind, that confusion is rampant throughout the health service. It is rampant among officers of the health boards who do not know where they stand in relation to this interim scheme, a scheme which was announced in July last to be serviced in the main through the VHI and for which there is not one iota of statutory authority. It is not good enough that the Minister should come here and totally disregard the scenario I have just outlined, when that has been the de facto situation since last summer, and to give the impression that there is an increase in the income limit when in fact the increase is not doing any more than regularising the situation which has obtained for almost four years. I regard it as an insult not only to the general public but to the House that the Minister should fail to make any reference to the de facto situation that has obtained and expect Members of the House to be so ignorant of the situation as to accept his bland request that we agree to these regulations without comment.
It is unfortunate that we should have to speak in this fashion to the Minister on the occasion of his first visit here as Minister with legislation. Surely the Minister should have considered it of vital importance to explain to us why public moneys have been expended through the VHI in respect of hospital expenses, consultants' expenses and general practitioner and maternity services expenses in respect of people whose incomes were between £5,500 and £7,000 last year and who are clearly not covered by the regulations signed by the then Minister for Health a year ago but who have had their expenses paid through the VHI even in cases where the people concerned were not subscribers to that board. Surely it would have behoved the Minister to explain what was the statutory authority for the health boards to have expended public money in respect of those in the £5,500 to £7,000 band. Would the Minister explain where the statutory authority was vested in his Department to allow them to expend that money in respect of those people considering that those regulations setting the limit for full eligibility at £5,500 are still law?
I accept that the Minister has inherited this mess of pottage and that the person who stirred the pot originally has now moved on to higher office but I would have expected that the present controller of the pot would have at least served up an offering to the House that would, in some measure, have gone towards explaining what had happened, when the increase in the income eligibility limit had taken place, how he or his predecessor had arranged the statutory authority for the change and, most important, why there is not now any increase in effect being made in the limit for eligibility. By merely regularising the position that has obtained during the past year and in view of the terms of the national understanding which provides for an increase in line with the increase in the CPI, a number of people earning less than £7,000 will automatically, because of increases paid to them within the terms of the national understanding, already have moved above the £7,000 limit. Therefore, when they get their P.60s showing their incomes for the financial year ending April 1980, it will be seen that their incomes will be greater than £7,000 and, thus, they will be removed from the eligibility net.
It cannot be that the Minister was ignorant of this situation because from this morning's papers, for example, we learn that he conducted talks only yesterday afternoon with representatives of the ICTU in relation to this very point. We read that the congress representatives very fairly made the point that, as they understood the matter, there was negotiated in the national understanding a ceiling of £7,000 in respect of their members and that the least that might have been done in the making of these new regulations would have been to ensure that people earning less than £7,000 at the time of reaching agreement on the national understanding but whose incomes have increased beyond that figure as a result of the terms that understanding would have continued, by way of changes in the regulations, to continue to have the benefit of the same degree of cover as they were enjoying at the time of the acceptance of the national understanding. That would not have been an improvement of the situation but merely a continuation of the existing level of cover. However, the Minister did not see fit to accede to that request and, consequently, what he is inviting the House to do this afternoon is to agree to a reduction in the number of people who have full eligibility for hospitalisation and for certain other health services. We are being asked to agree to the taking out of the net of a certain number of people and presumably this will be regarded as the continued phased improvement of the health services.
There is some difference in the statements issued after yesterday's meeting by the congress and those issued by the Minister as to what took place. In The Irish Times today we read that:
After meeting an ICTU delegation yesterday, Dr. Woods said that the eligibility for health services would be increased to £7,000 from June 1st, 1980, and would relate to income for the year ending April 5th, 1980.
Dr. Woods said that this would mean that persons whose earnings was less than £7,000 in the year ended April 5th, 1980, would now be eligible for the full range of hospital services, including free maintenance and all tests, medicines and consultant services in public wards.
Under the terms of the interim scheme to which the Minister's predecessor acceded last summer, is it not the situation that those services are already available to all persons whose incomes were less than £7,000 per year at the end of the financial year, April 1979? Is it not a fact also that the national understanding which operated in the financial year just ending will have taken a considerable number of those people beyond the £7,000 limit, thereby removing them once again from eligibility for the full range of hospital services, including free medicines and consultant services in public wards? Is this an example of the phased progress that we are to have in the health services?
Is this the measured, phased progress we are now to get in the health services—that the people who at present enjoy some cover are to be removed from that cover and the House is to be told that there has been an increase in the number of people covered because there is an increase in the income limits—when we all know that this is a charade, that the House is not being given the full facts of the situation?
I am sorry to say that I can only describe the introduction of these regulations as regressive because they have not taken account of the de facto situation and have not increased the income limit in line with the terms of the national understanding. I see a congress representative quoted in this morning's Cork Examiner as follows:
Mr. Cassells said the Minister's proposal would adversely affect the present entitlement to hospital service of thousands of workers. A large number of workers, mainly married persons, would lose the benefits obtained for them under the understanding. He explained this by pointing out that those on £6,000 at the beginning of the current understanding would pass over the £7,000 mark this year, and thus be left out of the free health services scheme.
This would not be my understanding of the situation because people would have needed to pass the £7,000 limit by the beginning of April 1980 so as to pass out of full eligibility during the financial year running on from then because the income in respect of which they would be assessed would be that earned in the financial year up to the end of April 1980. It is my understanding, looking at the national understanding, that people who had been earning somewhere in the region of £6,400 or £6,500 at the beginning of the understanding will, by virtue of its terms, discover that they have gone above the £7,000 limit by the time this financial year runs out in a couple of weeks time. Those are the people—how many I cannot say but I would imagine certainly thousands—who will move outside the full entitlement to services. Those are the people who will discover that, irrespective of the negotiations initiated by congress, the Taoiseach of the day and Deputy O'Donoghue, they will be materially worse off on foot of these regulations the House is apparently being invited to pass with acclamation this afternoon.
This scheme is still not a comprehensive hospital insurance scheme despite the comments made on its introduction, those made since and indeed those made by the present Minister at a certain time. This scheme still contains anomalies. One might have expected that the amendment of the regulations after a year would have sought to iron out some of those anomalies or injustices. Instead of that we discover that they merely iron out some of those currently entitled to benefit. We are now being invited to believe that it is an equitable situation that a single person earning £6,950 should be entitled to full hospital cover, including the cost of specialist in-patient and out-patient services, whilst a husband, with wife and five or six children earning £7,010 should find himself having to pay all of the costs—the specialist costs if they are in-patients or out-patients in hospital—having to pay also all of the costs of the general practitioner maternity services and indeed all of the cost apparently of the child/infant welfare referral service.
Is that a just or equitable situation? When we raised those points with the Minister's predecessor he was at pains—as he was so often in those times—to point out that he was tackling everything in a progressive, orderly fashion, that whilst he had not quite reached 100 per cent efficiency, he was aiming at that and that he would, in a phased way, eliminate all the anomalies in due course, with each year showing a gradual improvement in the services. He has gone. This is the first health regulation to be made since he left. It is regressive; it excludes people from these services, makes no attempt to correct the anomalies, does nothing to iron out the inequities and takes some of those people already eligible out of the system. That is the first piece of health legislation we have had from the Taoiseach's successor as Minister for Health.
I note also in this morning's Cork Examiner that:
It is understood that the Minister promised the unions he would have another look at this particular problem if Congress presented to him information concerning those who would fall out of benefit
A nice expression, "those who would fall out of benefit". I suppose that is another way of saying those about whom he is taking a deliberate, conscious decision to take out of certain benefit and who at present enjoy it. The quotation continues:
because of this year's pay increases, and indicated he might introduce some interim measures to cover this.
We are trying, almost at the end of March 1980, to find out details of the interim scheme the Minister's predecessor introduced last July. On the day on which we come in to discuss these regulations—which should throw some light on last July's interim scheme—we are told that the present occupant of the office, if he receives some information from congress—presumably he has not that information to hand—might introduce another interim scheme. Is this to be the latest panacea for all health ills, one interim scheme being built upon another until there is such a plethora of them we cannot see the wood from the trees?
Even bearing in mind the difficult financial circumstances in which we found ourselves would it not have been better to have taken the income of a person which the national understanding increases would bring to £7,000 and cast that in these regulations as being the figure for continued maximum elegibility? That would not have represented an improvement of the situation; it would merely have maintained the existing level of cover for the existing number of insured persons. That is not what was done. What was done was to take the figure that had obtained all through last year—which ignores increases granted to people under the national understanding—and cast that as being the statutory limit to operate for another 12 months.
I should like the Minister to explain clearly to us—apart from the ordinary adoption of the Estimates and Supplementary Estimates of the Department of Health—where the specific, statutory authority is vested in his Department for the expenditure of any moneys in relation to consultants' services and general practitioner maternity services in respect of people whose earnings were between £5,500 and £7,000 in the financial year in question. An obligation rests on the Minister to explain to the House whether—apart from the adoption of the ordinary and Supplementary Estimates of his Department—there was any other authority vested in his Department for the expenditure of moneys on those people, especially bearing in mind that there was a specific legislative machine, namely, regulations to be made under the Health (Contributions) Act, 1979, allowing the Department of Health to expend public moneys on consultants, hospital in-patient and out-patient costs and certain other charges. I want the Minister to explain to the House how the Department and the Comptroller and Auditor General are satisfied with the method whereby that money was expended.
Another anomalous feature which apparently these amended regulations will create relates to farmers. Full eligibility in their case was equated with a £60 valuation. As pointed out by the Minister's predecessor on 27 March 1979:
Following through in the existing traditional practice, we are equating the £60 poor law valuation with the £5,500 limit which gives you a multiplier of £93 per £1 valuation.
I am not sure it gives that amount. Apparently there is to be no change in the £60 valuation, but the regulations have been regularised to £7,000 which would appear to have changed the farm valuation multiplier from £90 odd to £116.6 per £1 valuation. I would have thought that this change in the assessment of the farm multiplier on the basis of valuation should have been adverted to by the Minister and explained by him. I hope that in his reply he will take the trouble to give the House the sort of information one would have expected to have been given in his introductory statement.
To illustrate the sort of difficulty this will create in negotiations for a future income understanding, when the £5,500 was set by the Minister the national understanding negotiators secured a limit of £7,000. At that time the ICTU had asked for a limit of something between £8,000 and £9,000 short-term pending the introduction of a no-limit scheme. It was only with great reluctance that the ICTU representatives settled on a figure of £7,000. If a year ago the ICTU sought to have all those with incomes of between £8,000 and £9,000 included in the insurance scheme and at that time reluctantly settled for £7,000, what limit would we reasonably expect them to settle for a year later in any new negotiations? It cannot be with any great degree of anticipation of success in future negotiations that the Government should now settle for a continuation of the existing figure in these regulations.
There is one hope. A year ago the Minister for Health stoutly defended the £5,500 limit and claimed it could not be bettered, saying it covered 83 per cent to 85 per cent of the population, that it was acceptable to the ICTU and to people generally, but he had his words thrown back at him within a few weeks when the Taoiseach announced acceptance by the Government of a figure of £7,000. Will the Minister for Health give us some indication of whether there is any likelihood that the Taoiseach, who has some peripheral knowledge of this situation, may also decide to increase the income limit for full hospital insurance cover within the next 12 months? There cannot be any doubt that the holding of these regulations at £7,000 can only have the effect of making any future agreement in relation to pay and wages more difficult to achieve.
I should like the Minister to explain the percentage of the population now eligible for full hospital insurance cover as a result of these regulations compared with the figure three months ago. I am not seeking for comparative figures from the point of view of the perecntage covered when the limit was £5,500 in April last year. What will that percentage be in July next, bearing in mind the exclusions the Minister for Health has decided to make from these regulations?
Another injustice and inequity which the previous Minister was pressed about and refused to mend his hand on is the case of the two-earner family where one is above the income limit for cover and the other below it, and where there are children. I have argued strongly in the House before that where there is such a family the State receives two contributions whereas if only one is working the State would have to provide the same hospitalisation insurance cover. If one such earner is above the income limit and the other below the limit, the State very unfairly and in a mean way assigns the children to the higher income earner and by so doing if the children have to go to hospital, though the State is receiving two sets contributions, they are not covered for consultants, fees, in-patient or out-patient charges.
Up to 1979, all manual workers irrespective of earnings had full cover for all hospital costs, including consultants. Through the introduction of this scheme last year, manual workers earning £5,500 and later £7,000 now discover themselves without cover for consultant costs. That situation has been continued. Indeed all the injustices, anomalies and inequities in the scheme last year are being perpetuated by the Minister in these regulations. The scheme introduced a year ago provided full cover for those earning less than £5,500. Some weeks later the negotiators for an agreement on incomes insisted that cover would be provided for those earning less than £7,000. In regard to the interim scheme introduced last year and referred to by the then Minister in the House on 23 October last, the Minister explained how much he knew at the time about how the scheme was to work. No explanation was ever given about where the money came from for the funding of that interim scheme. No reference was made to the operation of that scheme, the number of additional people it covered and the number of people covered by it who would be excluded by the passing of the regulations today. I hope the remainder of the Minister's period as Minister for Health will be happier for him, the House and those of us who have to deal with Health and that there will be no need again for the tone I have been forced to adopt in this debate because of the contribution the Minister made when introducing the regulations.
