I am grateful for the time given to me to address myself to this very important problem and I do not thank The Workers' Party for going through the futile ritual of calling a division and thereby depriving me of almost ten minutes of my time. As a result I will probably speak more rapidly than I would normally.
The VHI have altered rules 43 and 44 from 1 March 1985 or the next renewal of a member's contract. Rule 43 limits hospitalisation of a member to a total of 84 days in any period of 346 days with a period of 180 days between them. Rule 44 limits the benefit in respect of maintenance and treatment arising from alcohol, drugs or other substance abuse to two periods of hospital stay in a member's lifetime. The effect of these changes are discriminatory in that they are aimed at the most vulnerable section of the community, the alcholic, the drug addicts and the psychiatrically ill. These groups are not able or willing to fight their corner.
The saving to the VHI is likely to be little over £1 million and when this is compared to their claim level of £76 million in 1984, that represents 1.3 per cent of claims. It can be more readily seen that they have lost their nerve as far as treatment of alcoholism is concerned. They have sacrificed the great advances in treatment of alcoholism for a 1 per cent saving. It has always been the tradition in this Republic that the very strong carry the weak.
In the case of alcoholism the experts tell us that the disease will go under ground and that alcoholics will not be able to finance the cost of rehabilitation. The result is likely to be greater absenteeism and stress within the families of alcoholics. Alcoholism will be concealed to all except the family. It is a return to the sin model of alcoholism and the stigmatisation of this disease once again. From a statistical point of view the disease will be seen to reduce significantly whereas in fact it will be the treatment that will have been reduced.
The cause of the VHI problem is not alcoholism or long stay patients but the dramatic increase in public hospital charges which, from my information, I understand is 467 per cent since 1981. The volume of claims from public health hospitals must be added. Most hospitals increased their fees by some 8 per cent in 1985 whereas public health hospitals increased their charges by 20 per cent.
The result of the change of rule 43 is that patients who require long term treatment will come into the hospitals or health boards which are already overburdened. The cost will be £2 million in current expenses and perhaps several more million pounds in capital costs. Unfortunately those involved, alcoholics, schizophrenics, depressives and others require long term treatment. What I am asking, on behalf of the many organisations that brought this problem to my attention, is that the Minister use the statutory powers he has to ask the VHI to reverse the decision and allow a public debate to take place. The decision might be reversed even on an interim basis. My information is that the VHI took this decision without any consultation and certain sections of the health service feel aggrieved at the manner in which the decision was taken. This decision appears to have been taken without any public debate.
We know that alcoholism is a chronic relapsing illness. About 8 per cent of the drinking population become addicted making 100,000 people in the Republic alcoholics. For every alcoholic there are at least ten people affected by the illness in one way or the other, making one million people directly touched by the problem which is one third of the population. I am asking the Minister to instruct or direct the VHI to reconsider their decision.
Did the Minister consent to the change of rules 43 and 44 in relation to long stay patients? The many people who brought this matter to my attention is indicative of the deep concern felt by a large section of the community. The VHI appear to be an excellent organisation run with efficiency and courtesy. However, this decision appears to have been taken without consultation and in a manner which smacks of offhandedness. My proposition is that there must be consultation with all concerned, individuals and organisations. I appeal to the Minister to consign this decision to limbo pending a full debate.
Naturally there may well be, as has been suggested, abuses of the system but with monitoring such abuse could be eliminated. My information is that the abuses are mimimal to the point of being trivial.
As part of the general outcry, I will quote a number of prominent individuals who have interested themselves in this decision. I would describe it as a dreadful decision, a decision which hurts the particularly weak, vulnerable and possibly embarrassed section of our community. I am not a medical person and would not be competent to adjudicate on the deep issues involved but nevertheless as a public representative I am entitled to articulate, on behalf of those who brought this problem to my attention, the matters concerning them. In The Irish Times Tuesday, 12 March 1985 it was stated:
Professor Karl O'Sullivan, Director of St. Patrick's Hospital in Dublin, said it was a pity that the constraints on total hospitalisation in any one year would fall on the most vulnerable cases, such as those patients with schizophrenia, who may require more hospitalisation than the permitted limit of 180 days. And he added that some alcoholics also suffer from other serious psychiatric disorders for which they would require treatment.
He described as "very harsh" the limitation on the in-patient treatment of addicted patients and said he and his colleagues were very upset about it. It would be more reasonable, he said, to impose annual limitations and he conceded that some limitation on hospital use by alcoholic patients would be no harm, admitting that some abused the system. But he wondered why it would not be possible to identify those who went in and out of hospital a great deal and exclude them from open-ended benefit.
That appears to be a reasonable proposition. In the same article by Dr. David Nowlan, Medical Correspondent it was stated:
Mr. Donal Glynn, a clinical psychologist and assistant director of the Rutland Centre, also found the limit of just two periods of in-patient treatment for life for any addicted patient, "rather stringent". Given that alcoholism was a relapsing disease, he would like to see some clause in the VHI contract which would allow for occasional relapses.
The Minister will agree that alcoholism is an illness for life. It does not go away. It is there forever. The Minister might take account of that having regard to the stringent and strange decision by the VHI.
Recovery from alcoholism is possible but it is recognised as a chronic disorder. Treatment is conducted on a planned programme with a prolonged follow-up on an open-ended basis. The length of the treatment and rehabilitation process will vary depending on a large number of factors, including the age and condition of the patient, the degree of associated physical and psychological disability and social, family, legal and other associated problems. In all cases medical supervision and social supports are required on a long term basis because of the chronic nature of the condition and the potential for a relapse.
The last part of that sentence is important because the potential for a relapse in this illness is immense. But for the exceptional work done by our psychiatric private hospitals, public hospitals and Alcoholics Anonymous, we would have a far greater problem. There is no doubt that we have a great problem, an immense problem. I am asking the Minister to address himself to the problem and to explain in some detail the reasons for the decision. Does he consider it is appropriate to open up a public debate on the decision? A Cheann Comhairle, I am grateful to you for allowing me to speak on a subject which affects the very body of our nation. I am grateful to you for allowing me to speak on the Adjournment after a number of requests to be allowed to raise it.
