I would like to explain to the Seanad the reasons why this legislation has been found necessary and the purposes which it is hoped to achieve under the legislation itself. Members of the Seanad will have been provided with a White Paper dealing with the purposes of the Bill. I think if I briefly explain the existing legislation and what is sought to be achieved by the Health Act, 1953, and, in addition, what will be achieved by the present Health Bill, it might assist Senators.
At the moment in this country, provision is made in relation to health services under two different codes and for two different classes of persons. First of all, under the Public Assistance Act, 1939, provision is made for the sick poor, those who are unable to provide for themselves, those who, by reason of incapacity or lack of means, are unable to pay for medical care, surgical care, hospital treatment, or for the different services that their ailment, illness or condition might require. That class is provided for by the Public Assistance Act, 1939. Of course, the services provided for them are provided without charge, and they are as good as the country can provide at the moment. In addition, under our existing legislation—and when I say existing legislation I do not include the Health Act of 1953 which, in the context in which I am speaking, is not yet in operation—insured workers who are in benefit under the Social Welfare Act, 1952, are entitled to free hospital, specialist and other services envisaged in the Health Act, 1953. They are entitled to these services free not by reason of the fact that they cannot pay for them but by reason of the fact that, under the Social Welfare Act, they have a contract for the provision of these services and get them freely. These, broadly speaking, are the two classes of persons who, at the moment —subject to certain details which are not relevant just now—are entitled to free medical services—and both of these classes are entitled to these services in priority to anyone else. They are entitled to them in priority in every local authority hospital and also, in fact, in most of the voluntary hospitals.
Broadly speaking, that is the present position so far as our legislation is concerned. The Health Act of 1953 proposes to reorganise the health services of the country, to remove the existing code and to add new classes to the classes of persons at present receiving free treatment. Under the Health Act of 1953, provision is made to repeal the Public Assistance Act of 1939, to take from the Department of Social Welfare all insured workers and put them under the care of the Department of Health and, in addition, to add certain other classes as being equally entitled to free hospital and specialist services. These additional classes are to be found in Section 15 of the Health Act, 1953. The effect of that section is to provide that, from the date of the operation of the Health Act, 1953 instead of there being two classes of persons entitled to free hospital and specialist services there shall be five, and the five classes are as follows: (1) the sick poor; those, I have already defined to Senators; (2) insured workers; (3) all persons whose income is less than £600 a year; (4) all farmers whose valuation is less than £50 a year, and (5) all persons on whom payment for these services might mean an undue hardship. These five classes, under the Health Act of 1953, form a new pool or group of persons in respect of whom free hospital, specialist, medical and other services must be provided.
There are certain things which I would ask Senators to note with regard to the scheme under the Health Act, 1953. The first is that, in relation to these five groups or classes of persons, a statutory obligation is imposed by the Act itself on each local authority —or health authority, as it is called under the Health Act—to provide for all of these persons full hospital, specialist, medical and other services. The second thing I would ask Senators to note is that all of these persons are given equal rights to the services contained in the Health Act. No preference is given for the sick poor. No preference is given for the insured worker. No preference is given for any single person covered by Section 15 of the Health Act of 1953. Accordingly, in order that the services may exist in fact, and not merely on paper, it is necessary to ensure that full accommodation to cater for all these classes shall be available when the Act itself becomes law. If that assurance is not realised, certain undesirable results may follow.
If there is a statutory obligation on each health authority to provide equally, with short accommodation, for added classes, then someone will suffer. I am not concerned here and I am sure Senators are not concerned to investigate who is likely to suffer but it is not a good thing in our legislation to build up false hopes in the minds of people—hopes which we may know cannot be realised. If there is a shortage of accommodation, then either the sick poor, the insured workers, persons on an income of less than £600 a year, farmers up to £50 valuation who may or may not be badly off, or other persons for whom payment might mean an undue hardship will suffer because they would not get what the Health Act entitles them to get, namely, a bed in a hospital, the services of a specialist, free medical care and free maternity services for their wives during motherhood. That is, broadly speaking, the change proposed by the Health Act 1953, and the aims which it sets out to achieve.
When I became Minister responsible for the administration of this Act I was concerned to see that the Act would not merely gather dust on the files of this Oireachtas but that it should be examined as a practical proposition to see whether in fact the services which it assured the people of this country could be provided for them, and, if those services could not be provided in the immediate future, that they certainly should be provided within the foreseeable future. I accordingly examined what arrangements had been made to bring this Act into operation and what accommodation was in fact available to provide for the added classes and groups of persons referred to in the sections of the Act which I have mentioned. I think Senators will realise that in order to provide any health services it is necessary to have available not merely hospital accommodation but also the professional services of doctors, dentists, chemists, opticians, nurses and a variety of other bodies whose services are necessary to implement any scheme of health service.
I accordingly examined first of all what agreements or arrangements had been made with interested professional bodies, and I found that no agreement at all had been made with any professional body. Secondly, I examined what accommodation was available in our hospital system to provide the beds necessary for the care and treatment of all the persons who were assured of such treatment under the Health Act, 1953. I found this extraordinary position to obtain, that prior to the enactment of the Health Act, 1953, every county hospital in the country was providing service to an extent in excess of its proper capacity. Putting it in another way, the average bed occupancy in every county hospital in the country was more than 100 per cent. That meant that county hospitals, which were built in accordance with medical and architectural advice in the past and designed to accommodate a certain number of beds and a certain number of patients were, in fact, being forced to accommodate additional beds and additional patients. That was the position in relation to all county hospitals. In addition, all our voluntary hospitals in this city and elsewhere throughout the country were also providing services to the very limit of their capacity.
Accordingly, I came to the conclusion, as a non-medical man and as a layman charged with responsibility for the administration of health services, that the necessary accommodation was not available, and that even in relation to the classes now being provided for our hospital accommodation was not adequate. Accordingly, I felt that if, in face of that lack of accommodation, added classes and a large number of additional persons were given equal statutory rights in a time of shortage, very undesirable results would follow. I felt that, first of all, a premium would be put on the exercise of influence in every part of the country, that wirepulling would take the place of medical urgency in securing necessary accommodation for persons in need; and in these circumstances I thought it advisable to take steps to ensure that in relation to these health services we would apply them step by step strictly in accordance with arrangements that had been made and accommodation that might then be available.
I then examined the Health Act of 1953 to see whether under the Act I would have power by regulation to provide these services for different people in accordance with the facilities available for them. Might I just refer Senators to a provision in the Act, Section 22 of the Health Act, 1953, which is the section authorising the Minister for Health to make regulations dealing with the services to be provided for the people. Section 22 of that Act, I am advised, means this— that the Minister for Health in making these health regulations can do one of two things; he can either provide on paper everything for everybody, or he can provide nothing for anybody. Accordingly I found that under Section 22 I had to make regulations entitling all of the five classes that I have mentioned to equal rights in relation to health services and institutional and specialist treatment, or in any particular county I could refrain from making any regulations, thereby disentitling those who are now entitled to these services from any such services.
I was further advised that under the section I could not deal with any particular group of persons or any particular class, and that Section 22 impelled me to put the entire Act, so far as the services were concerned, into operation in relation to all these classes.
Accordingly, having examined the position in relation to agreements and arrangements and in relation to the accommodation that might be available and in relation to my powers under the Health Act, I came to the conclusion that it was necessary to ask the Government for authority to bring a legislative proposal before this Parliament. Naturally I can assure Senators, as I assured the Dáil, the decision which the Government came to was not taken hastily or without very grave consideration. In this country in relation to our health services we have had a turbulent history. There has been acrimony, controversy and disputing about health legislation over the past decade. It is not a desirable thing that every few months or every few years new health legislation should be introduced. It means a lack of continuity and a discordance in policy with regard to what is one of the very grave needs of the people. In addition, in relation to this Government I suppose political wisdom might have dictated a policy of sitting down and twiddling thumbs and doing nothing; but that kind of lack of action would not be a responsible course to follow. For those reasons, the Government felt coerced into asking the Dáil to intervene to ensure that, on the operation of the Health Act 1953, those people to whom this State owes a duty—either in accordance with the canons of charity or in accordance with contract—would not suffer. Accordingly, this Bill became necessary.
There is one matter I should mention before I deal with the proposals in the Bill—that of the steps taken by my predecessor in relation to the Health Act. I am not going to discuss matters of policy or anything of that kind, but I would just like to draw the attention of Senators to the fact that when I became Minister for Health unless a Bill of this kind were introduced and passed by the Parliament the Health Act with all its regulations would have come into operation in ten days' time. This position was brought about by the action of the previous Minister, first of all, on March 31st, in making a commencement Order bringing the Act into operation on August 1st. It is not possible for a Minister, when he makes a commencement Order, to get second thoughts the day after and to make another Order in place of the original one. Once an Order has been made bringing an Act into operation, the Minister is functus officio. The Act itself speaks from that time on and by reason of a day being named in the commencement Order the Act comes into operation on that day.
My predecessor made such a commencement Order on the 31st March, as I have said, naming August 1st as the date of operation. In addition, on the following day he appointed the National Health Council. That council was convened. The council had presented to them on last Holy Thursday, 15th April, seven sets of draft regulations upon which their recommendations and views were sought—but they were given a time limit in which to give those recommendations and views to the Minister. The National Health Council considered some of those regulations in the time available to them. It was not possible for them to consider them all. While they were still considering some of them, my predecessor, on the 15th May, made all the regulations law.
Those regulations dealt with a variety of health services. There were seven sets in all. They dealt with the provision of milk for mothers—no question arises with regard to that. They dealt with the provision of treatment for the mentally afflicted—again no question arises there. They dealt with general medical services—no question arises with regard to that. They dealt with various institutional services, and again no question arises. But on two of these sets of regulations—dealing with hospital and specialist services and with nursing and maternity services— serious questions arose as to accommodation and arrangements with other bodies. Nevertheless, my predecessor made those regulations law on the 15th May.
As a result of the general election held three days later, I became Minister for Health on the 2nd June. Accordingly, I was faced with the situation that the Act was coming into operation, that the regulations had been made and that, in regard to the chaos which I felt would result on August 1st no saving power existed except such action as Dáil Éireann and Seanad Éireann might take. Accordingly, this Bill was introduced.
I wish to say again, before I refer to the Bill, that the views which I have expressed as to the necessity for the Bill are not merely my own views. I have not come here to the Seanad in order to make a case. The views which I have expressed are views which have been expressed many times by many people in recent months. It is not possible for me to correlate all the different expressions of opinion that are available with regard to the practicability of providing the services under the Health Act on August 1st. I would refer Senators to the view expressed by the National Health Council as a result of its meeting on the 22nd June. The National Health Council is the advisory body on health matters, created by the Health Acts of 1947 and 1953. Their function is to advise the Minister on all matters relating to the health and welfare of the people. They may tender their advice without being asked to tender it, or they may give their advice in relation to a particular matter submitted to them by the Minister for Health.
This National Health Council was appointed by my predecessor. In its appointment, in the naming of its members, in its constitution or in relation to its powers I had nothing whatsoever to do. When I went to the Department the council was in existence; I knew it merely to be the national body established by the Act to advise me on matters relating to the health of our people.
Accordingly, under the Health Act, I decided in relation to my problem to ask the National Health Council what advice it wished to give me. I met the National Health Council for the first time, and the only time I met that body, on 25th June. I think I mentioned the 22nd June a few minutes ago; the date was 25th June. I addressed that body for two or three minutes—no longer—and explained the problem as I saw it and the difficulties I foresaw in bringing the Act into operation as an entire measure on 1st August. I then left the meeting and subsequently the National Health Council sent me, as a result of that meeting, the following advice:—
"The National Health Council, being particularly concerned for the legal rights of the poorer sections of the community, and also being aware of the uncertain position regarding the insured workers who already enjoy most of the services envisaged by the Health Act, 1953, urge the Minister to take whatever steps are necessary to postpone the repeal of the Public Assistance Act and the operation of Part III, inclusive of Section 23, of the recent Health Act until such time as may be essential to ensure that the proposed extension of the health services be initiated with a reasonable prospect of success."
I think that resolution, coming from a body constituted in the manner I have mentioned, should convince all Senators that the fears I held were well grounded. Naturally, I took the resolution tendered to me by the health council into consideration; I decided, however, not to accept their recommendation to postpone the repeal of the Public Assistance Act or the operation of Part III of the Health Act of 1953. I decided not to accept the advice to postpone the operation of the Health Act for a lot of reasons.
I do not like the Health Act, 1953. I have never liked it. I do not think it was a good way of setting about the provision of better services for our people: I do not make any secret of that. Nevertheless, as a contribution towards ending dispute about health legislation, I was prepared and am prepared to accept what has been done and I am concerned to make what has been done work and operate throughout the country. I sought for some solution which would enable me not to postpone the operation of the Health Act but to apply it in such a way that it would work for the benefit of the people as a whole and for that reason I felt impelled not to go so far as the National Health Council had urged. I came to the conclusion that the best approach to the problem of preventing the hardship and the chaos which would result from a premature attempt to provide services for which the necessary facilities were not available was to take power to regulate these services step by step and to bring in the hospital and specialist services and the maternity and infant services on such a step-by-step basis.
I then had to consider a factual amendment of Section 22 of the Act. That section is the section which governs the making of regulations and which makes no provision for a step-by-step approach to the problem. I considered that the best course was to amend that section to make it possible to provide for the bringing in of a service for a particular group within the wider groups set out in Section 15 in such a way as to apply the services under the Health Act in a rational manner.
The amendment I consider necessary is the legislative proposal now before the House. In relation to the Bill itself, Section 1 and 3 deal with insured persons who are already eligible for services from the Department of Social Welfare by virtue of their insurance and these sections are designed to relieve insured workers from a charge being imposed upon them by the Health Act, 1953; that is a charge of 6/- per day in relation to hospital treatment. Might I interpolate here that, as I have already explained to the Seanad, all insured persons at the moment by reason of their contract and insurance are entitled to hospital services without charge whatsoever. Under the Health Act, 1953, power was given to each health authority, if it so desired, to impose on insured workers a charge of 6/- per day or £2 2s. per week in respect of hospital and other services. Sections 1 and 3 of the present Bill are designed to remove for the time being that power from local authorities and to continue the existing rights of insured workers to free hospital and other services.
I have mentioned that I propose to move step by step after the 1st August with the addition of further groups to the groups for whom the services will be provided on that date. As soon as health authorities have had an opportunity of adjusting themselves to the change over on the 1st August, I propose to discuss with them the additional classes for whom they could provide services and, when I have satisfied myself that the facilities are available, to bring in new groups progressively within the limits laid down in the Act. Even if all the services provided for in the Act were in operation, I still feel that more must be done before we will have achieved what is the aim of everyone in the State who has given the problem serious consideration, that is, first-class health services within the reach of all. Therefore, concurrently with the extension of services under the Health Act, I propose to review the entire position. As a result of that review, I hope that, using existing services as a basis, it will be possible to produce a system which will end for our generation the controversy which, unfortunately, has for so long surrounded health legislation and health services.
Accordingly, I ask the Seanad to deal with this Bill as a sincere effort to make workable a piece of legislation with which I and a great number in this House and in the Dáil do not agree, an effort that is being made as a contribution to ending all dissension, disputes and controversy with regard to health services. But I do not ask the Seanad to accept this Health Bill or the parent Health Act of 1953 as being in any way a final measure in the provision of proper health legislation here. I think it will be possible, with this Health Act of 1953, in accordance with our own traditions, to work out far better services which will provide far better benefits for our people. It is my intention to work out such services.