As the Minister pointed out, this legislation was introduced because of a decision of the Supreme Court in 1983 in the Cooke v. Walsh case brought by the father of an infant who was injured and damages amounting to £757,538 were awarded to the child out of which health board expenses amounted to almost £100,000. The High Court decided in favour of the insurance company and then the Supreme Court took the view that it was ultra vires for the Minister to impose these charges under the various health Acts between 1947 and 1970. The plaintiffs in the case also maintained that this law was unconstitutional and that was not tried in the court because they succeeded on the ultra vires claim, so now we have this legislation.
While we are not opposing the legislation it is disappointing that the Minister has not looked at the area of the health services and their relationship to insurance companies and the question of payment in this type of case, to see if some other way might not be found to cut the cost to the citizen. Irrespective of whether the health services or the insurance companies pay the cost, it is always the citizen who pays through higher insurance premiums or through higher taxation to provide the health services. The Minister should have sought another way in which to deal with the more trivial accident cases than through the courts. While I accept that the Minister arranged that the charge may be waived in certain circumstances, it is interesting that the Minister did not stress that, where a claim is not made, there would not be a charge. I presume that would still be the case; that where a claim is not made the health board will not insist on claiming a charge for treating an injury.
Under the last legislation, where there was a trivial injury, say, for instance, a head injury where a person had to be detained overnight for observation and came out the following morning with a bill for say £300, nobody would have told him that he did not have to claim and that in that case they would not have to pay the charge. In that instance people who were worried about how they would pay the £300 would go to a solicitor for advice and a claim would be initiated. That involved a lot of expense to the insurance company which was passed on to those who paid insurance premiums. This put up the cost unnecessarily.
The Minister should have tried to amend this legislation so that insurance companies would give, without admission of liability, a grant to the health boards to pay some of the cost of treating people injured in road accidents who, because of the triviality of the injuries, would not normally take out a claim. What will happen as a result of this legislation is what has happened in the past. People who receive a bill from the health board for hospitalisation will go to a solicitor and litigation will ensue, at great cost all round. The Minister missed an opportunity to negotiate with the insurance companies to try to keep costs down. I accept that the health boards lose over £4 million per annum as a result of the Supreme Court case but another way might have been found to resolve cases rather than the long tedious court procedure.
In relation to injuries, the cost to the State and to the health services and medical profession in time and money should have been looked at by the Minister when drawing up this legislation. This is very important in times of recession and when there is a cutback in manpower. In conjunction with the Minister for Justice the Minister should have considered the court procedure in relation to road accidents and compensation claims. I will not go into whether or not a jury award or a judge award is appropriate. That is a matter for another Department. However, the Minister for Health should try to ensure that expensive consultants do not have to spend days at a time in the High Court.
I am disappointed that there is nothing in the legislation, or in the Minister's statement, to indicate his concern about the question of litigation and compensation involving the health services and consultants. The involvement of consultants in court cases disrupts the normal administration of the health services. There should be another way of dealing with such cases. It does not make a virtue out of the situation that it has been in operation since 1933. That is a good reason why it should be considered to see if it still serves the interests of the people, or if a more practical or a simpler method can be devised to do justice to the individuals concerned.
Another area which should assume major priority in the Department of Health is the question of the implication of so many accidents for the health services. We are all concerned with the human suffering caused to themselves and their families when individuals are injured or killed in road accidents. In 1984, for example, 465 persons were killed on the roads and 8,210 persons were injured. Of these 8,210, 1,000 suffered permanent disability. The cost of those accidents as estimated by An Foras Forbartha in their report for 1984 is £220 million.
The Minister must interest himself in this whole area of the prevention of accidents. I know other Departments are involved, but he must take a special interest in it because of the impact and implications of these accidents for the health services generally. You have only to look at any hospital at the moment and particularly the orthopaedic hospitals because bone injury is the commonest injury in road accidents. In the orthopaedic hospitals, approximately one third of the beds are taken up by accident victims. Consider the misery for those people, the suffering for their families, the cost to the health services, and the hidden factor in which the Minister for Health should take an interest, that is, the number of people on the waiting list for hip replacement surgery particularly in the orthopaedic units. They are suffering pain and are on the waiting list for well over a year and, when their turn comes, their bed may be taken up by the victim of an accident.
Many of these accidents could be prevented. One difficulty we have in legislation where a number of Departments are involved is that very often the legislation gets lost between the various Departments of State. Because of the responsibility on the Minister for Health to ensure the best public health service for the people, he should initiate a programme of prevention of all accidents. This legislation deals exclusively with road accidents and, for that reason, we are confining ourselves to road accidents, but the Minister should initiate a programme to try to ensure that we will prevent as many of these accidents as possible. He should initiate a comprehensive prevention plan involving all the Departments that should be involved.
The Department of Education would have a major role to play here in that they cannot start too soon to teach young children about the dangers, the road code and how to avoid accidents. The Department of the Environment have a major role to play and they have introduced some very good legislation, for example, the seat belt legislation. There is no doubt that that has saved numerous lives and prevented serious injury in many cases. It is encouraging to find that 70 per cent of the people have been wearing their seat belts over the past few years, but still we are not near the 90 per cent who wear seat belts in other European countries. The Department of Justice have a major role to play in implementing the laws and, as I have said, the number of persons wearing seat belts has increased. The drunken driving legislation has been good, but it is disappointing that we are still allowing persons to drive cars with alcohol levels in excess of those in any other European country. As long as we have the number of accidents we have and the number of persons injured, we must take the necessary measures to ensure that we will reduce accidents to the very lowest level possible.
The loss to the Department of Social Welfare in terms of the social insurance fund through disability benefit for persons injured in road accidents is another area that the Minister should be concerned about, as the same Minister has responsibility for Health and Social Welfare. I am sure he is concerned about it but, if we could cut down on the number of persons who lose work as a result of injury, we would be making a major contribution to the people by preventing the accidents and also a major contribution to the social insurance fund by saving unnecessary drawings from it.
I would like to have seen this legislation embodying a legislative package including a number of areas where we could deal with the very serious problems that we have with 465 persons killed and 8,210 injured in 1984. I am disappointed that the legislation is not more comprehensive and that a greater effort was not made to see if some solution could be found other than a very cumbersome method whereby the injured party must go to court to face long drawn out proceedings. In his opening address the Minister of State recognised that the health board charge will not become due until the case is settled, which may take years and longer again if the treatment takes longer than that.
On that point I ask the Minister if that means that a person who is awarded compensation must pay unforeseen health charges arising out of unforeseen complications of the accident. The Minister said that charges shall accrue on the date on which damages are paid or on the date on which the services are provided, whichever is the later. If somebody is injured in an accident, the claim is settled in three years' time and the person is awarded compensation, and in five years' time he has to get treatment for some unforeseen complication of the accident, will he be obliged to pay for that out of the compensation?
I should like to ask the Minister another question. He stated in his press release on 2 July 1985 that the effect of the proposed legislation would be to restore the position which obtained prior to the Supreme Court judgment. Is that the case? Is the position restored to that which obtained prior to the Supreme Court judgment? In other words, are voluntary hospitals affected by this legislation and, if so, how? The legislation refers specifically to health boards. In the Cooke case which was responsible for this legislation coming before the House, the damages were divided. Some of them would be hospital expenses and others would be consultants. Under the legislation will there be a charge for hospitals and consultants or just for hospitals? While we are not opposing the Bill, we are disappointed that the Minister did not avail of the opportunity to take a radical look at what is necessary in 1985. He should not have come into the House and given us the impression that the charges proposed were correct because the system has operated since 1933.