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Dáil Éireann debate -
Thursday, 24 Mar 1988

Vol. 379 No. 5

Health Contributions (Yearly Reckonable Income) (Variation) Regulations, 1988: Motion.

There is a strict time limit to debates today and I would ask for the best of order. Time is of the essence.

I move:

That Dáil Éireann approves the following regulations in draft——

Health Contributions (Yearly Reckonable Income) (Variation) Regulations, 1988

a copy of which regulations in draft was laid before the House on 16th March, 1988.

Subsections (2) and (3) of section 9 of the Health Contributions Act, 1979, provide that the Minister for Health may vary the income ceiling which determines the amount payable by an individual in a particular contribution year.

Subsection (5) of section 9 of the Act requires that a draft of the proposed regulations shall be laid before both Houses of the Oireachtas and that the regulations shall not be made until a resolution has been passed by each House approving of the draft regulations. The draft regulations now before the House shall apply in relation to the contribution year commencing on 6 April 1988.

The income ceiling is at present £15,000, and it is proposed to increase this to £15,500. In determining the proposed increase in the income ceiling, I have taken into account — as required by the Act — the most recent information available regarding the average earnings of workers in the transportable goods industries since the last income ceiling was adopted. The latest recorded information on average weekly earnings in those industries relates to June 1987 when the average figure was £196.76, which was an increase of 5.2 per cent on the June 1986 figure of £186.92. When this percentage increase is applied to the current £15,000 ceiling, a new ceiling of £15,780 emerges. However, it is proposed to set the new ceiling at £15,500, which is more in line with the 3.2 per cent increase in the CPI to mid-August 1987. The effect of this increase in the ceiling is to increase the maximum amount of health contributions payable by persons with incomes in excess of £15,000 per annum, who will pay only an additional £6.25. Persons with incomes of £15,000, or less, will not be affected by this increase.

The proposed increase in the income ceiling will bring in about an additional £1 million in the contribution year 1988-89. Of this, about £250,000 should arise in the financial year 1988. The balance of the additional yield, about £750,000, will come in the first quarter of 1989.

The Revenue Commissioners are responsible for the collection of current health contributions from all sectors. The health boards remain responsible for the collection of arrears due from farmers, for periods up to 6 April 1984. The total amount owed by farmers to health boards at 31 December 1987 was about £5.7 million. While the amount which is still outstanding is a cause for concern, there has been an encouraging response to the efforts of the health boards to recover these arrears. A total of £1.4 million was collected in 1985, £1.1 million in 1986 and a further £426,000 in 1987.

Deputies will be aware that health boards can retain these arrears, including any arrears collected in future years, as additional revenue to be applied to local health services' needs, and the health boards have now initiated legal proceedings to recover arrears wherever this is appropriate.

In addition, the Health (Hospital In-Patient Charges) Regulations, 1984, came into effect on 1 June 1984. These regulations allowed for an admission charge of £100 — which sum was subsequently increased to £150 on 1 July 1986 — to be levied on persons admitted for hospital in-patient treatment in a public hospital who are in arrears with health contributions. This has proved to be quite an effective measure in inducing defaulters to pay their health contributions. However, I should mention that persons in arrears are not refused admission to hospitals, but the collection of the admission charge and the arrears is pursued later.

I am anxious that outstanding arrears should be collected as soon as possible as it is clearly unfair that those who do not honour their obligations with regard to health contributions should continue to obtain health services at the expense of others.

As the House will be aware, the Government have decided to change the basis of income tax assessment for the self-employed and to extend liability to this sector for PRSI contributions. They have also stated their intention to apply the same assessment, collection and enforcement procedures as will apply henceforth to income tax also to PRSI health contributions and to youth employment levies paid by the self-employed.

I would now like to take this opportunity of informing the House that I am at present having regulations drawn up in my Department to give effect to this decision in relation to health contributions. When these regulations, together with other appropriate legislative provisions sponsored by the Ministers for Finance and Labour, are in place, health contributions together with PRSI and the youth employment levy will be aggregated with a self-employed individual's income tax liability and will be demanded and collected in a single sum. At the same time the regulations which I propose to make will, in accordance with the budget announcement, also provide for the deduction of capital allowances in the calculation of the reckonable income of self-employed persons who are liable for health contributions.

I am sure that all Deputies will welcome the main thrust of these measures which will, to a very great extent, streamline the assessment and collection of tax, levy, PRSI and, what I am primarily concerned with in these regulations, health contributions, by removing any duplication at present inherent in the assessment and collection system. The individual taxpayer will also benefit from being able to discharge his full taxation and contribution liability to the State in one transaction.

I shall be reviewing shortly the income limit for free consultants' services. I am not, as yet, in a position to say what the limit will be.

I now ask the House to approve the regulations before it in draft.

It would be very easy to accept what the Minister has said but in reality a further £1 million is being taken from the public this year for an inferior health service. Along with the £1 million, many health boards are implementing an administrative charge for services to which people are legally entitled. I will be dealing with that briefly in a few moments. In fact people will be paying more for a diminishing health service. We have seen graphic evidence in recent times of the consequences of the Minister's hamfisted attitude and actions. The poor, the old and the handicapped are being deprived of a service.

It is only in the last month or so that the consequence of the Minister's decisions have come to public attention. We have seen evidence of that in Ennis Hospital and the children's hospital in Crumlin. When the North Infirmary in Cork was closed an assurance was given by the Minister that we would get an adequate casualty service there but the medical staff are complaining that the service is dangerously low. The Mercy Hospital is overcrowded, staff are at a cracking point and the Southern Health Board state that the accident and emergency service at the Regional Hospital in Cork is not in a position to cater for the demands being made on it. We have longer waiting lists, an inferior service and doctors and nurses under great stress because of the pressures being put on them. Hospital equipment is not being replaced or repaired because of a shortage of money.

Administrative charges are being imposed by some health boards on those who apply for hospital services cards and E1 11 cards. People are legally entitled to those cards but health boards are imposing a charge for the processing of applications for them. Some weeks ago the Minister told the House that the Department would investigate the legality of such charges and I wonder what they have decided. The Southern Health Board have made a reduction in the charges but not removed them altogether.

Our people will be paying £1 million more to the Government next year as well as having to pay more for private insurance cover. It is not surprising that there has been a dramatic increase in the membership of the VHI because the people cannot get the public service they are entitled to. In the public sector there are long waiting lists and that has led to a growth in private medicine.

A recent report by the Southern Health Board showed that some of the consultants in that area are indulging in 50 per cent of private practice in public hospitals. That has arisen because people are being forced away from the public health services. I should like to ask the Minister, before he imposes any charges, to bring negotiations on the common contract to a conclusion. Those negotiations have been going on for some time and we have all heard of the widespread abuses of the common contract. The softly softly attitude of the Minister towards his colleagues must be condemned. We have a small percentage of consultants who are milking the system for all it is worth but the Minister is not doing anything about them.

Community services have deteriorated in the last 12 months to such an extent that the unemployed are being asked to pay their travelling expenses to hospitals. In the last 12 months the Minister has succeeded in reducing the quality of the service. I do not accept that the fact that the number of acute beds per one thousand of our population is up to the standard in other European countries is an indication that everything is in order. There is evidence of a crisis in our hospital services. Our poor people are suffering. Those who can afford to pay for medical treatment can obtain it within a matter of days while the poor, and those who must depend on the public service, have to wait months and, in some cases, years.

Staff in the health services are demoralised and the Minister has succeeded in developing a two-tiered health system, one for the rich and one for the poor. I must repeat, because the Minister has not contradicted my statement, that deaths have occurred because of the cutbacks. Last year I was challenged by the Minister for Finance to produce evidence of that. I gave evidence of a case in County Waterford and it has not been refuted. I have been waiting five months for a reply to that statement.

The Government have played a great confidence trick on our people in promising an efficient health service. Our people have to contend with a very inefficient service. When the Minister took office he did not have any policy for the health services and we are now suffering as a result. Before he imposes any further charges on the public the Minister should produce a comprehensive health care policy. The objective of a health policy should be to provide a modern health service for the population with the best quality that is available, to provide accessibility to the service on the basis of need rather than on the basis of demand which can be unduly influenced by income or geography. To make the system efficient, effective and flexible we must ensure that the best use is made of the limited resources available.

I am flabbergasted to think that the Minister has not challenged the bureaucratic nature of management in our health services. He has not done anything about our health boards. In my view the eight health boards pursue their own policies. I have evidence of people being refused a benefit by one health board and being told that they were entitled to it in another area. We have different standards, mismanagement and over-management but the Minister has refused to tackle those problems. In my view the reason the Minister has refused to tackle the eight health boards is that they are political vehicles.

There is evidence that there is gross mismanagement in our hospital services but the Minister has closed his mind to reports of internal committees of boards of management in our hospitals. We have had a lot of lip service about what the Department were doing in regard to community care but I have not seen any evidence of that. In fact, community care is at a dangerously low level. Staff are not being replaced. We are agreeing to the motions today with reluctance but I should like to warn the Minister that he must come forward with a comprehensive health care policy sooner rather than later. The public are demanding it. People are suffering as a result of the cutbacks in the last 12 months. We are at crisis point.

I support the calls for the setting up of an all-party committee of the House to investigate our health services. We cannot depend on the Minister, or his Department, because what happened to those services in the last 12 months was as a consequence of the Minister's decisions. We have to depend on the doctors and nurses for our information. An all-party committee should carry out an investigation into the consequence of the Minister's decisions in the last 12 months. I will not pursue those matters further because of the limited time for the debate on these motions.

I support the call by Deputy Allen for the setting up of an all-party committee to investigate our health services. It is badly needed and Members should be more involved in policy formulation in areas such as health and education. They are appropriate areas for Members to be involved in the decision-making process. Many criticisms have been levelled at the Minister for Health but, generally speaking, he is doing a good job and I should like to compliment him on that. Many of the changes he has made were badly needed but it is important that any further changes are made within the context of the budget allocation voted by the House some months ago.

However, when choices have to be made in hospitals as between bureaucracy and the provision of additional staff to provide a service to the public the cutbacks should first fall on the administrative and bureaucratic side. I am not at all convinced that that has been done to the maximum possible extent. I agree with Deputy Allen's comments about the need for rationalisation of our health boards. We do not need eight health boards. In the main they consist of political appointees with the result that decisions are often made not on the basis of what is in the best interests of the health care of the people but on the basis of political instructions. If one county or one region has more representatives on a health board than an adjoining county or region very often a decision is made to keep a hospital or a service going in the county with the maximum number of representatives on the board. The decision may bear no relation whatsoever to the need involved and the best interests of the health services.

Many decisions are made purely on the basis of the political interests of the day and that is not good enough. Those who shout loudest, who lobby most vociferously, get their way by putting pressure on the various political representatives who sit on these boards. Generally speaking, the county or region with the greatest influence on the health boards will get its way against another area that might need the service more. The Minister should look at the whole question of the health boards structure, at their make-up, the need to rationalise the number of health boards and ensure that we do not have a health care system which is administered essentially at local and regional level by politicians.

I was a member of the Dublin local health committee, now defunct or almost defunct, and I am not sorry that it is going or gone. I found it a most useless body. The information that could be got at such a committee could have been easily available with an efficient system of administration in the health boards by picking up a telephone or writing a letter. Invariably, the meetings consisted of councillors putting down questions about when certain buildings were going to be opened, or when a certain person would get into hospital. Besides being a waste of time for the members, including myself, it was an enormous waste of time for the many health care workers who had to attend and staff these meetings and compile the information to deal with the various questions scheduled to come before the committee. There was a cost involved in having meetings. While the cost of travel to and from the committees in the Dublin area would not be high because the distances were short, in other parts of the country people had to travel long distances involving a totally unjustified waste of money.

The increases in the health contributions represent an increase of £1 million in taxation. Those of us who have looked at Mr. Lawson's proposals and the analyses of them in some of our papers and the comparisons made between our tax system and the British one will see very clearly that the disincentive effect of increases in taxation here have enormous implications. Many are leaving this country today who have or could have jobs here but are choosing to go because of the high levels of taxation being taken from incomes. We must seriously consider this matter in the context of the overall development of the economy and of giving people an incentive to work and to work harder. Increases in taxation of any kind, whether in the form of health contributions or whatever, are all forms of taxation taken from income. They have a further disincentive effect on work, effort and enterprise. Whether we want to or not, as a small country so close to Britain we cannot close our minds and eyes to what is happening there and in other countries where taxation is coming down. Very often, we stand to lose the people we can least afford to lose. Particularly at the lower end of the scale there is no justification for taking contributions, whether in the form of PRSI, health contributions, or whatever, from people on very low incomes. It creates an enormous trap for those who would probably be better off if they stay on social welfare as opposed to going into the work force on low incomes. We need to look at the possibility of not taking taxes or contributions from, say, the first £2,000 or £3,000 of income.

With regard to the Minister's comments about the collection of the levy from the farming sector in particular, it is a disgrace that that sector of the community owes in arrears to 31 December about £5.7 million in health contribution levies alone and there are greater amounts of money owed by them. The leaders of the organisations involved should become as vociferous in asking their members to pay this contribution as they are in telling them not to make other payments or to lobby politicians about other things that are happening. I have rarely, if ever, heard them say loudly that they want their members to pay these contributions which they owe — and owe to the taxpayer. Because they do not pay them, the rest of the community have to pay the contributions for them.

I am delighted that the incentive is being given to the health boards to collect the money, by being allowed to keep what they collect. I am also pleased that legal proceedings are being taken against those who have not paid. Given the cost of legal proceedings in this country, there probably will not be much left if we have to go the full way to the court. Nonetheless, it is an important point of principle and we should go the full way in making sure that the State gets this £5.7 million from that sector.

I welcome the suggestion that one procedure will be adopted for collecting this levy from the self-employed and farming sector together with PRSI, taxation and so on, which proves my point that it is additional taxation. However, it is more efficient that the State would collect all the moneys due to it by one simple method and the same should apply in relation to——

I must now call another speaker.

We should co-ordinate these things and they should all be done at the same time.

The Labour Party have no objection whatsoever to paying additional health contributions, or to raising the ceiling from £15,000 to £15,500. But — and this is a very major "but"— we do object vehemently to paying substantial additional taxation in the long term while, simultaneously, services are being dismantled. The purpose of health contributions is to finance the health services. Never in the history of our party have we hung back from paying for those services and we know that we must pay for them. However, we object that the ordinary PAYE worker who pays this charge of £1.25 per cent on gross income up to £15,500 is not being provided with the very services for which he is paying. This Government have been singularly ineffective in the provision of these services and singularly ill-advised.

Public beds which people are entitled to by virtue of category 1 or category 2 of the health services are being closed down. It is now extremely difficult, if not impossible, for an elderly person to get into an acute general hospital on a matter of urgency, say for geriatric assessment, and to have normal care. I shall give the examples of a couple of hospitals in my own constituency. St. Michael's Hospital from the month of May to the month of October will not take in any booked admissions at all. St. Vincent's Hospital has had a whole ward closed down and converted to private beds in a desperate effort to get in some VHI money. One senior consultant in that hospital told me he is no longer doing any continuous work; he has been dealing with emergencies only since last December. Basic services are being disbanded.

Nurse training, which was always regarded as a major outlet of employment and professional skills for young women, has been almost destroyed and was certainly not helped by the appalling foolishness of An Bord Altranais in trying to rationalise admission procedures. Orthopaedic and ENT services are in a total shambles. A GP told me the other day that he knew a medical card holder, a child of 14 years of age, who was bluntly told it would take two years before he could have a tonsillectomy.

People in Cork have to wait three years for that operation.

It is a public disgrace for the Minister to say here this morning that we must increase health contributions to provide health services. However, the GP to whom I referred told me that if the 14 year old boy went to a consultant on a private basis, he would be operated on within two weeks. People are suffering and are becoming very irate.

Health education has also been abolished although part of the contribution was meant to pay for it. There has been no reform in the health board's structure and there will not be any because it is dominated by Fianna Fáil — not only in terms of the last local election — but because of ministerial appointments to the various boards.

Nothing is happening either in relation to the GMS. There is a need to bring in an effective capitation system but this will not be done because the really strong vested interests in the health service will not be taken on. The VHI are getting into more and more trouble. Most Members of the House are in the VHI and they face an increase of 8.5 per cent in the ordinary A, B and C schemes and closer to 9 per cent in relation to the D scheme. The VHI have had a £15 million operational loss which was offset by about £7 million or £8 million income from portfolio investments. Nevertheless, towards the end of the year, they will be demanding a very substantial, further increase.

I disagree with the comments made by Deputy Harney in relation to the British tax system. She referred to the fact that taxation had been reduced to 40 per cent in the UK with a base rate of 25 per cent, but at what a price. The British Prime Minister and the Chancellor have taken billions of pounds out of the health services and given them to the rich and the super-rich. We do not want that to happen in this country but there should be an incentive to care for people. The problem facing the Minister for Health is that the Minister for Finance and his other colleagues in Cabinet railroaded him out of £40 million or £50 million of basic health expenditure in 1987 and 1988. I hope he will now resist them and tell them that he will not accept further reductions and cuts in 1989. The Minister was also railroaded in relation to health contributions. The Minister said he would get an additional yield in this area but, as far as I know, the yield in health contributions for 1988-89 will be down by £1.3 million because the income of the self-employed and farmers will be calculated on capital allowances. That means that the yield will be down substantially. There is a contradiction in what the Minister said here and what the Minister for Finance told me by way of written reply, that there will be a £3 million drop from the self-employed and farmers on health contributions and the employment levy in 1988-89, about £1.2 million in health contributions and £1.8 million on the employment levy.

I have no objection to the ceiling going up to £15,500 provided that the money will be used for the health services but it is going into the general maw of appropriations-in-aid of the Department and the Minister's budget is being cut. For every extra increment he gets from appropriations-in-aid the Department cut his budget back and leave him in an equally difficult situation. Now that we have a break of some weeks, the Minister should address himself to the common contract which his predecessor, Deputy Haughey, brought in in such an appalling manner.

I urge the Minister to bring about, in the next budget, uniformity of health contributions and other levies. The PRSI ceiling contribution is £16,200 and the ceiling for the health contribution is £15,500. I tried very hard to get a uniform ceiling — I tried to abolish the ceiling altogether — and I urge the Minister to do the same. They should be averaged out and there would be no loss of yield. Of course, the trouble about abolition is that they still will not give you the money.

I received an apology from the Whip's Office this morning as I came into the Chamber because I had not been advised of what was happening here today. This item was not on the Order of Business for the week and we were not aware that it was coming up.

The first objection I have is that the increase in the contribution rates is not accompanied by an increase in eligibility, which is extraordinary. The Minister said that he would shortly be reviewing the income limit for free consultant services but that he was not yet in a position to say what that limit would be in regard to eligibility ceiling. Yet he introduced this before he was in a position to see whether people paying this contribution will be eligible. I cannot understand why the eligibility is not increased at the same time as contributions. Is this legal and constitutional? I do not know. I also do not know why we need to rush this measure through on the last day of a sitting, which seems to be a very popular day for doing this. Just before the House adjourned for Christmas, we rushed through the Bill dealing with fishing licences.

We know that 30 per cent of the adult population qualify for hospital services cards which means they also qualify for out-patient and in-patient services. They are paying between £150 and £200 a year in contributions to the health services. As the previous speaker has said, we have to look at whether it is a contribution to the health services or not. Do these contributions give them any rights? Separate charges can be imposed for in-patient and out-patient services, therefore their contributions are not related in any way to the health services being provided. The Eastern Health Board are now trying to introduce a charge for the issue of hospital services cards. They are going to charge £10 for applying for a hospital services card and this despite the fact that a person is paying up to £200 a year in contributions for these health services.

Although paying 1.25 per cent of their income towards these health services they are not getting the services which they are paying for and in fact they are having to pay extra for the services which in turn is driving them towards the VHI. Again I must ask, is what the Minister is doing legal and constitutional? If people are paying 1.25 per cent of their incomes for health services, surely they have a legal right to receive these without paying further for them. This would be similar to the VHI saying that, although they were making their contributions, they would also have to pay their bills. One wonders what the thinking behind this is and whether it is legal and constitutional.

The greatest scandal of all is that while the Minister is going to bring in an extra £1 million by raising the contribution level to 1.25 per cent he is not bringing in the money which is due from those making no contributions the self-employed and farmers. Deputy Harney, referring to the Minister's speech, said that it is terrible that there is £5.7 million outstanding but if we read the Minister's speech carefully we will see that that is only the amount of money outstanding to the health boards up to 6 April 1984. Since 6 April 1984 these contributions should have been made to the Revenue Commissioners, therefore all the money outstanding since 1984 was not mentioned by the Minister and he did not say how much was owed by the self-employed and farmers in health contributions since then. I understand that the figure is in the region of between £36 million and £38 million and this despite the fact that the Minister introduced a laudable scheme whereby if they did not pay their health contributions they would be charged for the services they received.

Presumably, this has brought money in from those who have got ill but they amount to only a tiny percentage of the total. The vast majority, just like the vast majority of PAYE workers who are paying between £150 and £200 a year in contributions, never get ill. The vast majority of PAYE workers never avail of these services but at least they know that if they did get ill the services would be available and that they were contributing towards the health care of others. Those who are not contributing are paying for no one's health care, neither yours nor mine. The contributions which PAYE workers are paying have gone up from 1 per cent to 1.25 per cent, yet eligibility levels have not been raised. This is as a result of the refusal of the self-employed and farmers to pay their health contributions and the refusal of the Government to crack down on them so as to ensure that they do pay their contributions. What goes for one citizen should go for all.

The biggest problem in the taxation system is that citizens are not treated equally, they are discriminated against depending on their job and source of income. If there is an easy way of ripping them off, it will be taken. There is nothing to stop the Minister from increasing the contribution level from 1.25 per cent to 1.5 per cent and of course it will be the same people who will end up paying this increase. He could then increase the charges for in-patient and out-patient services to £20 a time at the stroke of a pen. I ask, where do we stop?

While these regulations propose to increase the figure from £15,000 to £15,500 they also raise the issue of the contributions and the services which one gets in return, whether those contributions are paid into some type of health care fund in order to ensure that the services are provided or whether as, was stated by the previous speaker, they would go into the big maw of the Minister for Finance. The big problem is that the Department of Finance are cutting back on the number of workers in the health services — as was pointed out yesterday there are now 1,500 fewer workers in the health services — and when you cut back on the number of workers in the health services you also cut back the number of services provided to those paying contributions of between £150 and £200 a year. They have been paying these contributions for years but because the money is not there they are not getting the services in return. If the money was put into a health service fund rather than into the maw of the Minister for Finance, then the money would be there and that is the nub of the question in regard to the health services. The £36 million outstanding is precisely the amount of money which would be required in the current year to keep the health services at their previous level.

I would like to refer to some of the points raised by the Deputies opposite. Reference was made to the fact that the health services are in crisis but I would like to say that nothing could be further from the truth. There is no such crisis in the health services. Let us take the acute hospital service: such a service is available to anybody who needs acute treatment. I accept that there are waiting lists and that there always have been waiting lists and that in some specific services, such as the orthopaedic service, the waiting list is much longer than we would wish. Other countries have similar problems and I am looking at this area to see if anything can be done to improve the situation. The general medical service was protected by the decision of the Government to provide a further £25 million on what was allocated by the previous Government when we came into office in 1987. There has been a further increase this year so as to ensure a good community care service would be provided.

The Minister is out of touch with reality; he should take a walk with me some time in Cork.

Four Dublin hospitals are receiving £109 million between them, yet Deputies say that the services are falling apart.

They are falling apart, as I know first hand in Cork and elsewhere.

There is £1,300 million being spent on the public health services. That amounts to 18 per cent of current spending. We have the same problems as other developed countries in that it is not possible to provide the level of finance which the health services could absorb. Countries much wealthier than our own such as Germany, the United States and the United Kingdom find the same difficulties we are facing up to.

As I have said, the GMS has been protected and has been provided with large percentage increases in funding since we came into office. Reference was also made to the consultants and the common contract. The common contract was due to be reviewed in 1986 when the Fine Gael and Labour Government were in office but they did nothing to bring about that review.

(Interruptions.)

I am glad to say that we got that review under way——

(Interruptions.)

Similarly, there are very positive constructive negotiations going on at the moment with the GMS. I hope they will come to a satisfactory conclusion and I will certainly try to expedite them.

Deputy Mac Giolla suggested that the eligibility ceiling should be increased at the same time as the health contributions. Two issues arise here. First, eligibility is claimed on 1 June so that employers can issue tax documentation to employees so as to facilitate employees when applying for hospital services cards. Also, delaying the eligibility ceiling until June means that eligibility is not determined on the previous year's income and that has an obvious advantage for the employees.

On the question of policy generally, we are working to a policy and I am glad——

There is no policy.

——to see that at a conference in Beaumont in the autumn, representatives of all the various people——

(Interruptions.)

——working in the health services were present and there was general agreement with the thrust and direction of our policy. I was very pleased at that.

You have codded them for four years.

There is a policy. We have rationalised the acute hospital services. We have——

You butchered them.

——protected and are developing community care services. I accept there are gaps and I have referred to the waiting lists. In the next couple of months we will be producing reports on the care of the elderly and on the care of the mentally handicapped.

I must now put the question.

I thank Deputies for their contributions.

The question in relation to the constitutionality of administrative charges——

In accordance with the decision of the Dáil of this day, I must now put the question.

Question put and agreed to.
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