This is the section which deprives a society of power to expel a member. The amendment is to increase the pecuniary penalties which a society can, under the present Act, impose on a member for gross misconduct. If you are taking away the right of expulsion it would appear that you ought to give a society the right of imposing a heavier penalty than it has power to impose at present for gross misconduct. I understand that a similar amendment was proposed in the other House, and that as far as these pecuniary penalties are concerned the Minister was quite willing to accept them, but the amendment was ruled out of order by the Ceann Comhairle. Of course, I cannot ask you, sir, to give a different ruling from the ruling given in the other House, and I do not for a moment suggest that you should. For that reason, I would be obliged to withdraw the amendment. I understand, however, that further legislation is contemplated in the near future on this subject, that this is not the final Bill, and I have no doubt that the Minister will see the justice of giving this increased power of pecuniary penalties to societies from whom is taken away the right to expel a member.
National Health Insurance Bill, 1929—Committee Stage.
As regards the first part of the amendment, we would have been willing to accept that, but intrinsic in the Bill itself there is a latitude which would enable the penalties to be increased, if the circumstances warrant that. For instance, the scale of penalties is between ten and twenty, and perhaps the fines will tend towards the higher side of that particular scale in future rather than towards the lower side. But, intrinsic in the position itself, there is the possibility of dealing more strictly with delinquents. As regards the second part, I would have been prepared to oppose that. There is power to deal with that under regulations. But the penalty as expressed there would work out too severely. However, we have power to deal with it under regulations and, if it is necessary to do so, it can be done.
I move:—
Section 8, sub-section (1). To delete in lines 15-16 the words "unless the Insurance Commissioners in any particular case otherwise direct."
This section deals with the deferring of right to benefit in certain cases. I wish to delete the discretionary power there given to the Commissioners. I am quite aware that it may give rise to some hardship, as, for instance, when an employer has an employee who is insurable and the employer is either too negligent or too mean to stamp the card until that person is likely, through illness, to apply for benefit. Then he stamps the card, and the person wants to become a member of an approved society. That is a hardship. Nevertheless, I think it is better that the administration of the Act should be tightened up and that this hardship should be got over by a more rigid scrutiny of those whose cards should be stamped and are not stamped. The form of legislation which gives a certain discretion to an official is, I think, undesirable. It is better to have the law uniform in all cases and apply the same rule to every case that comes along. Sometimes, even with the best-intentioned officials, cases come along which do not hang together. One case where a hardship exists may be turned down, and, in another case, when the official is in a more relenting mood he will yield in the circumstances. That subjects the whole administration to criticism, which, to my mind, ought to be avoided. I am aware that the Commissioners have a discretion now, but I think it is better, as we are proceeding with a Bill to consolidate the whole principle of insurance, that that discretion should be omitted.
An Leas-Chathaoirleach
took the Chair.
The provision in Section 8 is intended to secure that, a period being prescribed of three months inside which persons make up their minds as to what approved society at the earliest possible moment. It is intended to prevent non-compliance. It is intended to prevent a person who actually does get his cards stamped going round with his cards for a year or a year and a half and then when he gets ill, putting his cards into an approved society and wanting to join. It is desirable to force people to join a society at the earliest possible moment. There are three months given in which to do it. It is also desirable to have some discretion where cases of real hardship arise, such as the case the Senator mentioned. There might, for instance, be a case of a young girl going into service where the mistress does not want to go to the expense of paying the insurance. The young girl possibly gets ill and the mistress dismisses her. The girl then goes to the National Health Insurance Commissioners and complains about the case and the Commissioners have to take up the matter with the mistress to see that she does comply with the Act. Simple compliance with the Act would merely mean the moneys being paid into the Commission. There is also the girl's side of the question, as she has to get some benefit. In a case of hardship on an appeal like that to the Commissioners, the Commissioners go into the matter and have the right to decide after the money is paid in that the benefit shall not be denied to the party in question. All the cases are dealt with in a most systematic way and come up to the Commissioners for final decision. I think the question of discrimination really does not arise at all. I suggest to the Senator that that appeal should be left in the Bill.
Amendment put and negatived.
I move amendment 3:—
"To delete the section."
This section is really a code dealing with the case of married women. The Minister, in introducing the Bill, said that the funds of the societies might be seriously depleted if he continued to married women the advantage they derive from the earlier Act. If I have misunderstood the Minister, I am sorry, but he certainly, either in reply to a question in the House, or in the course of his speech, said that the provisions of this new section would help the fund in some way. I understood from him that the position of a woman who gets married after this Bill comes into operation will be somewhat worse than her position at the present time. In view of that, I have made a comparison of the two sections—the section which it is proposed to abrogate and the section that it is proposed to enact. I find there are a good many advantages which married women still have under existing legislation which they will not have under the provisions of this Bill.
In the first place, under the Act of 1918, marriage does not disqualify a woman from continuing to be an insured person. The next advantage she has is that she is entitled to sickness benefit of five shillings a week, to maternity benefit of thirty shillings a week, and to medical and sanatorium benefit for twelve months; and there is in the Act which it is proposed to repeal this very important proviso to sub-section (3): "Provided that no woman shall by reason only of so becoming employed be deprived of any benefit to which she would but for the provisions of this sub-section have been entitled unless and until she becomes entitled to corresponding benefit by virtue of her new insurance." The thing is very complicated, but in the Act which it is proposed to supersede care is taken that in no circumstances will the married woman be worse off by reason of her marriage or of her reemployment.
Then there is another provision in this Bill before the House which seems to me to be objectionable. It is sub-section (5) of Section 15, which states: "The amount of a marriage benefit shall be such amount as is prescribed by the Insurance Commissioners, and in prescribing such amount regard shall be had to the effect of arrears, the duration of insurance and the number of contributions paid." Under the old Act, the whole thing is regulated by law. A married woman knows exactly what she has to get. There is no discretion, so far as I can see, left to any Minister or to the Department. But here you have a case of discretionary power such as Senator Dowdall objected to in connection with the previous section. Here, again, discretion is given. That power may be used, and the sentiment of the Minister would be to use it to the advantage of people, but still it could be used and must be used to the disadvantage of other people because there is only the same fund to draw upon.
Senator Brown, in moving his amendment, intimated that this, perhaps, would only be in effect a temporary measure, because the whole scheme of insurance has to be taken up. I think that the Minister should very seriously reconsider Section 15, or rather that code of law which it introduces in respect to married women. There may be cases where the moral sentiment of individuals might be touched. There are certain cases where a woman might have a certain urgent need for getting married and where she may be entitled to maternity benefit very soon after getting married. Cases of that kind may occur and they become a charge upon the fund, of course, but I do not think it is really worth while legislating for that one kind of case. If they are so unfortunate as to be in that position, they ought not to be put to the added misfortune of having their insurance benefits curtailed. I submit for the consideration of the House that the section of the Act of 1918 is a better section from the public point of view, and certainly from the point of view of the unfortunate working women who have become wives and mothers, than the present section. Of course, I understand how difficult and dangerous it is in a Bill of this description, which has been carefully thought out, to ask the Minister to strike out a vital section, but it seems to me it ought to be struck out and the existing law retained if it is at all possible. In any case, the spirit of the existing law should not be departed from merely because there may be a case of an unfortunate woman who gets more than her share of insurance, but I leave the matter to the consideration of the House.
I am afraid I do not quite understand the Senator or the Senator does not quite understand the proposals under Section 15, and he probably is imagining something in Section 15 arising out of some of my remarks on Section 19 (1) the other day. I direct the attention of the Seanad to the Interim Report of the Committee of inquiry into the National Health Insurance Act, page 9, Section 33, where it says "A large body of evidence shows that the administration of the special benefits in class K to insured women who cease insurable employment on marriage is a source of considerable trouble and difficulty to societies. Whilst the evidence is not unanimous all the witnesses who represented purely Irish societies have with one voice proclaimed the difficulty of administering Class K scheme. The only witnesses who favoured its continuance were representatives of societies the parent body of which was outside Saorstát Eireann. We are therefore forced to the conclusion that a case has been made for the simplification of the changes which on marriage take place, and we recommend that in lieu of the present benefits under Class K a cash endowment be paid to every insured woman on marriage. The normal amount of this should be actuarially determined, the actual amount paid being, of course, subject to a deduction in respect of arrears of contribution."
With regard to married women, under the Act the position is that if a woman during the first year of her marriage is unemployed for a period of eight weeks, she automatically becomes, instead of an ordinarily insured person, a person under class K and becomes entitled then to these benefits:—certain retained benefits under the sanatorium scheme for a period of two years; for a period of eight weeks sickness she becomes entitled to a payment of 7/6 and she becomes entitled to her maternity benefit inside that two years.
As far as her being an insured person before marriage, when her Class K benefits wind up, after a period of two years her insurance history is finished. If after passing into Class K she comes back into employment again, she re-starts insurance. The administration, as it was pointed out, of Class K benefits has been difficult. An administrative change is proposed here, by which, instead of having these different benefits allocated to her over a period of two years, automatically, on marriage, a woman's history as an insured person for that particular period, at any rate, ends, and she is given a gratuity which actuarially will be the equivalent of maternity benefit which she would have got if she drew maternity benefit within two years, or sanatorium benefit, and a benefit of eight weeks' pay. It is simply from the point of view of a woman herself and administration ending her history on marriage. If after marriage she comes back as an insured person, she re-enters as an insured person and continues to draw all benefits which would have been payable if she had entered insurance at that particular time without any question of marriage at all. So there are no benefits a woman was entitled to under previous Acts that she is to be deprived now of under Section 15, but a different way of giving her benefit is being instituted.
I think Senator Comyn is wrongly advised when he speaks of a woman on marriage being in a less advantageous position. I think the chances are that her monetary position would be at least as good as it would have been if this had not been passed, but there are other sub-sections which seem to me to require explanation, and I would be glad if the Minister directed his attention to them in the course of his reply. He said that the position of a married woman on re-entering employment, and, therefore, on re-entering insurance, is the same as an unmarried woman who has remained in insurance.
I am advised that in Section 8 and in the further sub-section that the married woman re-entering insurance is not in as advantageous a position as the unmarried woman. For instance, in the case of a married woman I am told if there are arrears she will be obliged in these circumstances to pay up all arrears before she can come into benefit, whereas in the case of an unmarried woman there is a certain limit—she may pay—up to three, four or five shillings, sufficient to bring her into benefit, not necessary to bring up all arrears. That is to say, there is a distinction drawn between an unmarried woman who has remained in employment and therefore in insurance, and the married woman who has gone out of insurance but reentered on becoming an employed person again.
I have also been advised that the effect of sub-section (12) is to continue an undesirable practice in the case of a married woman. She may call upon the society in five or ten years' time for benefit which she did not claim at the time she was entitled to it, and there ought to be some limit to the period during which a woman who is entitled to benefit should claim for that benefit, because societies are not always in the habit of keeping their books, records and files for an unlimited time. There ought to be a limit inserted during which a claim should be made.
My chief point is, there is a distinction drawn, or will be in the future, between the position of an unmarried woman and a married woman re-entering employment. If the Minister could correct me in that I should be glad. If not, I would like him to take it into account in the hope that in any new legislation coming there will be a reconciliation of the two positions.
What about the position of a woman who, on marriage. continues in her employment? I would ask the Minister this: whether the gratuity on marriage to the working girl is of the same value to her as the advantages which she derives under the old section, the maternity benefit and the sanatorium benefit, and I ask the Minister again whether the object of this section is not this—to give to these women who get married in general less out of the insurance fund than they have been getting up to the present.
There is no intention in this Act that married women will get less out of the insurance fund than they have got in the past. The gratuity that will be given to them on marriage will be actuarially an equivalent of what they would have got under the other system. Assume that a woman marries on the 22nd May, having been at work up to the 21st, or, if you like, having been at work on the 22nd, and suppose she turns in again on the 23rd, her history as an insured person ends on the 22nd May by the paying over to her of her gratuity under this section, and she re-starts as an insured person on the 23rd May as if she was never in insurance before. That is the position with regard to the woman who was in insurance.
Suppose she needs maternity benefit within a few months?
Her gratuity is intended to enshrine the possibility of maternity benefits and the possibility of sickness and sanatorium treatment, expressed actuarially in cash. In reply to Senator Johnson, there is nothing in sub-section (8) that is going to prejudice a married woman as against an unmarried woman. Sub-section (8) says:
Nothing contained in the foregoing sub-section shall operate to prevent a married woman who has been employed for at least the prescribed number of weeks in any period being deemed to be a voluntary contributor for the purposes of any regulations made under the Acts with respect to benefits of persons in arrears.
Married women are not entitled to be voluntary contributors, but it may be that they have only a certain number of contributions paid up. In that way they may find themselves entitled to decreased benefits at a particular time. All insured persons have power to pay up contributions that are in arrears, in order to put themselves into full benefit with the insurance societies. In the case of a married woman who has less than forty contributions in a particular year, at the end of her insurance year she is reminded that she is in arrears and she can pay her arrears up to forty contributions or more if she desires. Persons who want to put themselves into full benefit, if they have less than forty contributions paid in each of two consecutive years would not be allowed to pay up arrears at the reduced rate, but would have to pay the full voluntary rate. There is a regular arrears table set out, and persons who are in arrears can pay certain amounts that are not necessarily the equivalent of the exact stamps that would ordinarily be paid. These provisions apply to ordinary insured persons as well as to married women. So that there is nothing in sub-section (8) of Section 15 that is going to operate against the married woman. What Senators probably have in mind is Section 19 (1).
I thought that was connected with Section 19 (1).
It is only connected in this, that Section 19 (1) prevents the paying up of qualifying contributions by the woman herself in respect of employment commenced inside the first year of marriage, because it is pointed out that in the first year of marriage certain illnesses and disabilities are likely to arise, and for purposes of receiving benefits a married woman may enter into insurance for two or three weeks with the connivance of a particular employer and then, becoming sick, would want to pay qualifying contributions herself which would give her a claim to benefit to which she was not really entitled. Here you want to avoid a woman coming into insurance for a short period only in a particular year of her married life and coming into benefits simply by paying contributions herself.
Sub-section (1) of 19 only applies to the first twelve months?
The first twelve months: "After the date of her marriage and within twelve months thereof she shall not be entitled, in respect of any period during which she remains an insured person commencing from the date on which she again becomes so employed, to avail herself of the provisions of sub-section (2) of Section 13 of the Act of 1918."
Is there any provision here limiting the time at which she should receive this gratuity? From my experience, a great many of these things to which people are entitled are not paid up when they should be. Frequently it is months and months after, and sometimes they run to over a year before the moneys are paid to which the people are entitled. If anything could be done to compel payment within a certain time it would be a great advantage.
If a person becomes entitled to a certain thing and does not actually draw it——
They cannot get it.
——there is an appeal to the Insurance Commissioners.
I do not want to press this amendment. I think we have got now from the Minister a hint as to what he means—a hint just.
Since I put down these amendments I had the advantage of speaking to the Minister, and he really brought me to see that the terms of his clause are as liberal as could be. In these circumstances I ask permission to withdraw the amendments.
I move amendment 6:
Section 23, sub-section (4). To add at the end of the sub-section the words:—
"Provided that in the case of an official who has fifteen or more completed years of service with such committee his actual period of service may be increased by the addition of such number of years not exceeding seven as may seem just, having regard to the particular circumstances of the case; and thereupon his gratuity shall be calculated upon such increased period of service."
This amendment is merely a permissive one, enabling the years for the purpose of calculating the amount to which a secretary or an official of an insurance company would be entitled to be increased in certain circumstances, with a maximum of seven years. The existing arrangement is that redundant officials with less than ten years' service get a gratuity calculated at the rate of one-eighth of their annual incomes from their position, whilst those with over ten years' service get a gratuity calculated at the rate of one-sixth. My amendment merely provides in the case of an official who has fifteen or more completed years of service with the committee that his actual period of service may be increased by the addition of such number of years, not exceeding seven, as may seem just having regard to the particular circumstances of the case and thereupon his gratuity shall be calculated upon such increased period of service.
The people I have in mind are those who may be found to have had this as their only means of livelihood. They are mostly people who were appointed when these committees were first formed in 1911 or thereabouts, so that they would have seventeen or eighteen years' service. They helped to bring the organisation into operation. There fell on them all the heavy work consequent on the war in administering sickness and disablement benefits to discharged soldiers. I understand they got no additional remuneration for this work, although their pay was originally fixed when work of this kind was not contemplated. They entered the service because of special qualifications and at a time when they had reasonable expectation of permanency. I agree that they were liable to dismissal on three months' notice, but I think they might reasonably be said to have had a good prospect of permanency provided they discharged their duties capably.
Some of these men must now be at least over forty years of age. They are at a time of life when it is exceedingly difficult for them to get employment elsewhere, and the amendment would enable special consideration to be given to cases of hardship, so that where the officials concerned had no other means of livelihood or no other means of any consequence. something might be given to them. There is nothing compulsory in it; it is left absolutely as a matter of discretion, and I hope that the Minister will see his way to accept the amendment, because he will probably find a few cases where it might be found very desirable that there might be some years added. It is to enable him to exercise that discretion that I move this amendment.
I would ask the Senator to take into consideration what has happened since the introduction of this Bill in the Dáil, and I will ask him not to press a purely permissive amendment. In discussing this matter in the Dáil I pointed out that as far as the Local Government Department was concerned the type of persons who, taking into consideration their duties with the duties here would be analogous in respect of pensions, would be the employees under the school attendance committees, whose compensation for loss of office under the 1926 Act was fixed at not more than one-tenth of their annual salaries and emoluments for each year of service. However, in the Dáil an increase was made on that to the extent that persons with less than ten years' service were to get a gratuity based upon one-eighth of their total salary and emoluments for each year of office, and those with ten years or more service were to get a gratuity based on one-sixth. I also explained that the amount of work falling on those officials since the introduction of tuberculosis schemes in a more general way throughout the country has been comparatively small. It would be like this: the amount of funds available through the insurance committee in one particular county was £902. That £902 was handed over in a lump sum to the secretary of the board of health or the secretary of the county council; the names of persons entitled to sanatorium benefit were submitted subsequently, and the clerk of the committee received a total salary of £157 10s. in respect of work that was certainly part time. In twenty-three of the counties very little work was being done. Even where schemes were administered by the committee this position was a part-time one.
Except in Dublin.
Even in Dublin the secretary of the Committee had other employment, and he was part-time to that extent. Under the Local Government (Temporary Provisions) Act, 1925 a standard was laid down as to compensation for loss of office in respect of full-time pensionable officials of local bodies, and the position of such officials whose services were dispensed with, due to loss of office is, in the case of persons with less than ten years service, that they get a gratuity of one-sixth of their total emoluments for every year of service, and persons with ten years or more get a yearly allowance based in practice on the adding of some years to the total amount of their years of service, based upon one-sixtieth of their annual salary and emoluments. If we compare what is being done in respect of part-time officials of sanatorium committees and what would be done under our scheme in respect of pensionable full-time officials of local bodies we can get a measure of the fairness with which the officials of the sanatorium committees are being treated. If we take the secretary of an insurance committee with fifteen years' service and approximately forty years of age, under the proposals in the Bill for every £100 of salary and bonus he gets one-sixth for fifteen years, a total gratuity of £250. If we take his work as one-third of full time it would work out that he would be entitled, with fifteen years' service, to a sum, the present value of which would be only £175 as against the £250 we have here. If we take the value of his work as half full time, he would be entitled in the first instance to an annual allowance of thirteen and two-thirds pounds, the present equivalent of which for a man of forty years of age at £175, would be £230. So that if you take them as pensionable and find out the value of their services in terms of a fraction full time, and even if you say that they work half time, you will see on that basis they are getting more than they would get if their compensation was figured out on the basis that is set down in the Local Government Act of 1925. We have gone as far as we reasonably can, and I would suggest to the Senator that the insertion of a purely permissive clause such as he suggests would not be of any use.
In view of the very strong attitude taken up by the Minister I agree with him that the insertion of a purely permissive clause would obviously be of very little use, and I do not believe in introducing anything into a Bill that is not going to be operative.
The amendment which stands in my name is a long one, and I do not intend to read it to the House, because I am not going to propose it as an amendment to the present Bill. But perhaps the House would bear with me for a few minutes while I explain its nature. Section 23 abolishes tuberculosis benefit, and it puts an end to the insurance committees which carried out, as far as the societies were concerned, the collection of the funa that was the finance of this tuberculosis benefit. The way in which tuberculosis benefit was worked and financed was this: a sum was paid by each insurance committee to the county council or the board of health, or whatever the body it was —it was either a county council, a council of a borough or a board of health. A certain sum was paid by the insurance committee to that council. Out of each 1/3 making up that fund the sum of 9d.—that is, three-fifths of the 1/3—was devoted to paying for maintaining people in sanatoria. Out of the other two-fifths the salary of the tuberculosis medical officer and his travelling expenses were deducted and the balance was expended under a definite standard agreement which 22 out of the 27 districts had entered into, that it was to be available for domiciliary treatment for people who could not get into a sanatorium, or for dispensary treatment. That was the agreement between 22 out of the 27 districts. The others were slightly different; one of them at least being much more favourable as far as sanatorium benefit was concerned.
Under the Bill sanatorium treatment is abolished, and instead of the contribution paid annually by the insurance committees to the councils or boards of health, an annual grant of £27,500 is paid by the Government. It is to be divided in proper proportions between each of the county councils and the boards of health. Each is to get a contribution from that grant in lieu of what they got from the insurance committees. Section 24 (4), to which my amendment applies, provides for the application of the three-fifths of the 1/3 out of the annual grant. In sub-section (4) of this section two-thirds of the money that goes out of the annual grant to the county councils or the boards of health is to pay for tuberculosis benefit in sanatoria. I should have said that before that happened the whole amount is first carried to the credit of the general expenses account of the tuberculosis fund, the whole system of tuberculosis relief in this country. Out of that two-thirds is taken for sanatorium benefit, but nothing is said in the Bill about the other two-fifths. Under the contracts they had with the county council the other two-fifths was allocated, one-fifth for the salary of the medical officer, plus one-fifth for expenses, and the balance went quite definitely towards the relief of insured persons in their own homes or through a dispensary. Now there is no provision for that two-fifths at all, and the persons who are responsible for the administration of these societies are afraid that they will not get the same benefits from the contribution which is now coming out of the annual grant as they were getting out of the moneys formerly paid by the insurance committees to the councils and boards of health. They may be right or they may be wrong. It is rather a serious question. I am prepared to withdraw this amendment, because it is a very arguable and difficult subject, asking the Minister to take into serious consideration the case that can be made for the persons who are responsible for the administration of these societies— and for whom I am speaking—for an amendment of this kind, and if they can persuade him that they are right, that he should introduce it in subsequent legislation.
The sub-section which Senator Brown proposes to substitute by his amendment is really introduced to persuade doubting Thomases that they were losing nothing. The position generally is that tuberculosis schemes throughout the country under boards of health have developed enormously since sanatorium benefits came to be involved in the National Health Insurance scheme. When sanatorium benefit was included in the National Health Insurance scheme there was no provision by which State assistance could be given to schemes throughout the country. When the Act was passed it was seen that it would be necessary to provide for non-insured persons, and the Act of 1912, I think, made an arrangement whereby fifty per cent. of the expenditure on tuberculosis would be State borne. Whereas in 1922-23 the amount given in State grants as part of the tuberculosis schemes was £21,000, implying an expenditure out of public and local funds of £42,000, the expenditure in 1928 from the State was £41,000, implying an expenditure of £82,000. The estimate for the current year is £59,000, implying an expenditure of £118,000, so that we have gone from an expenditure of £42,000 in 1922 to £118,000. I pointed out that in the development of the schemes the amount of State money provided swamps completely the whole amount provided by the National Health Insurance schemes. I want to point out whereas receipts from patients who were able to pay are recoverable under the Act. that comparatively speaking is a dead letter. In Monaghan where the amount expended for the year ended 31st March, 1929, was £3,051 nothing was collected; in Co. Waterford where £2,040 was expended only £10 was collected; in the Country Borough of Dublin where £35,308 was expended only £330 was collected from private persons so that the amount collected is negligible. The stipulation that money can be collected from private persons might well remain as a deterrent to people from entering in the tuberculosis scheme when they are perfectly well able to pay for their treatment. So that insured persons need have no fear good, bad or indifferent that they are going to get less treatment than they got in the past.
Less free treatment.
Yes, less free treatment than they got in the past. I am not able to give particulars as regards insured persons who have been charged anything. I would like to ask if anyone knows any insured person who has ever been charged anything? If there are any such cases, the number would be very small. I think the Senator is completely safe in withdrawing his amendment, because, under the scheme, as already put into operation, two-fifths was more or less completely absorbed in the salaries of tuberculosis officers for dispensary and domiciliary treatment, while three-fifths was available for institutional treatment. The facilities for institutional treatment are growing more and more every day. In nearly every county now you have local facilities for the treatment of advanced cases. If, at any particular time, it did transpire that any very serious wrong was being done, I certainly would be prepared to deal with it and give sympathetic consideration to the matter. I suggest that the money available for National Health Insurance people is really swamped in the other public funds that are being provided, and that there is no insured person who need have the slightest fear that he is being wronged under the present Bill.
I know the intention of the Minister was that there should not be any injury inflicted by a change in the administration of the tuberculosis fund. I know that is what he stated in the Dáil. What I have asked him to do is to take up any case that is put up to him in regard to sub-section (4) of Section 24 and to give it his careful consideration. If the Minister is willing to do that, I am prepared to withdraw the amendment.
Certainly.
I want to know from the Minister whether under Section 24 any existing rights that insured persons have are being interfered with. I draw attention to the following words in sub-section (4): "So long as the total cost of institutional treatment afforded by them to such persons in such year does not exceed three-fifths of the sum distributed." What is going to happen to a person who is in an institution at any period when that sum of three-fifths is exhausted? Can the Minister, the local authority or the institution demand a payment from the insured person out of his own purse, out of the family purse or from some source other than that of the insurance fund? If insured persons are to be deprived of any of their existing rights, I think the Minister ought to give an assurance to Senator Brown that if such cases are brought to his notice he will go into them and see that the Bill is amended at a later date.
A local authority at the present time, when the insurance funds are exhausted, can charge persons even though they are insured persons for tuberculosis treatment.
If they are able to pay?
Yes, but the figures that I have quoted show that generally, and not altogether from insured persons, the powers which local authorities have under Section 11 of the 1908 Act to get payment from persons who they think are able to pay, are practically a dead letter.
Though the question may not be altogether relevant to the Bill, I would like to ask the Minister if there are any returns published showing the result of the tuberculosis campaign? Is there anything to show what benefit people have derived from it? A good deal of money has been spent in combating tuberculosis and people would like to know what the results have been.
A lower death rate.
The matter is dealt with generally in the annual report of the Local Government Department. Reports have been published in two volumes, one dealing with the period 1922-25 and another with the period 1925-27. As Senator Johnson pointed out, there has been a steady decline in the death rate from tuberculosis for a number of years. I think the Senator will find the graph in the last report of the Registrar-General.
Would the Minister say if there are people who would feel that tuberculosis treatment was a legal right for which they were paying their insurance contributions but who would not claim the benefit of the tuberculosis scheme because they might feel they were getting State charity? Would there be a psychological element which would prevent people applying for tuberculosis benefit?
I cannot say that. Sanatorium treatment for people suffering from tuberculosis was provided for in the National Health Insurance Act without any idea that the finances of the scheme actuarially would bear that. That was taken out of the British scheme, I think, in 1920 and now we are taking it out of our scheme for the reason that actuarially the finances of the National Health Insurance cannot carry it, and because of the fact that the money that is being distributed to the local bodies does not cover the amount of tuberculosis expenditure on insured persons. Considering the very great expense in treating tuberculosis cases, I do not know there would be a feeling on the part of people that they would rather not take advantage of the institutions set up all over the country for the treatment of tuberculosis. The system is very much cut away from the poor law; particularly as a result of changes in the poor law system that have taken place here. I do not think we have anything to fear that way. We have the figures I mentioned to show that people are increasingly taking advantage of the facilities provided for tuberculosis treatment. I have not had the matter brought before me.
I am anxious to know who will administer sanatorium treatment in the city of Dublin in place of the old insurance committee? Will that committee remain, or is it exempt?
No. All the insurance committees will go.
Who will be responsible for the administration in Dublin?
The medical officer in Dublin and whatever committee controls him. In fact it will be done by the Dublin City Commissioners, on the public health side.
It will not be the Commissioners of the Union?
No.