I will verify that, but it is my recollection that it does not appear in those terms in the Health Act of 1953 but it is by reference ascribed to the Public Assistance Act of 1939.
The Senator argued that because we were increasing the income limit for entitlement under the Health Act from £600 to £800 we should do something more for the farmers. First of all I have made the case that the real purpose of this Bill is to bring back within the scope of the Health Act those extruded from it by reason of the increases which have taken place from time to time in their money incomes. There has been no change in the valuation of farms. The same number of people on the farms are entitled to the benefits of the Acts as were entitled when the Act was first passed, and in fact I may say that it is very difficult to see what more one could do in the remaining cases. I have mentioned that the general average for the country of the number of people who will be within the scope of the Act as amended will be about 85 per cent. At the present moment the number of farmers under £50 valuation in Connacht is 97.4 per cent. of the farming population of Connacht. In the three counties of Ulster the percentage is 94.9. In Munster it is 82.7 and in Leinster 74.3. It seems to me that there cannot be any great hardship among those who do not come within those very comprehensive fractions.
A person who owns a farm of £50 valuation has a very valuable property, whereas another person has perhaps a more or less precarious existence; in so far as he depends on the general state of the economy and on another individual or corporation for the day-to-day employment which gives him his livelihood. In those circumstances we are not doing any injustice to the farmers when we are merely trying to redress in relation to wage earners and persons in similar circumstances the position in which they now find themselves, and restore them to the position in which they were in 1953 in relation to the Act.
Senator Fearon seemed to think that we were breaking entirely new ground. That has been the basis of the objections raised on behalf of the medical profession; but we are merely endeavouring to recover lost ground or to bring back and reinstate on the original ground the people who were driven off it.
I have no doubt that the services have been readily and easily available, and therefore some people are perhaps getting benefits under the Acts to which they are not entitled; but I do not think there is a very significant number of such people. It is no greater now than it ever was, and in fact if anything I should be surprised if it is not significantly less, because I have taken the line that these services are costing so much and are now so highly developed and highly specialised that no person should get them free if he can make a reasonable contribution to the cost of them. The complaint I generally receive is not that somebody is getting the services who is not entitled to them, but that persons entitled are not getting them. It would seem, taking these latter representations, that it is unlikely that there is any very substantial number of persons getting the services who are not entitled to them.
The suggestion has been made— Senator Fearon mentioned it too —that one of the consequences of raising the income limit under the Act will be that local authorities will tend to clamp down on outpatient departments. That is not my experience of local authorities. They behave responsibly and try to give the benefit of the Health Acts as widely as possible. Their tendency is rather to look for greater expenditure than to try to cut it down. I do not think there is any very great danger that they will reduce the scope of the services now available.
We should of course like to see these services extended to the maximum extent that would be useful, but again we have to consider in this connection the overall cost. The cost of the services now runs in the order of £16,000,000 a year. I have tried to keep it to that figure. Whether I can succeed in doing it this year I do not know, but if I do not do that and if the Minister for Finance has to increase the standard rate of tax I shall hear a great deal of moaning and gnashing of teeth in this House when I come along, if I should happen to come along, with another Bill to increase the medical benefits which might be provided.
I do not know that the Bill is going to impose any very great strain upon the existing hospital facilities. I gather that when the Act of 1953 was going through the House it was represented that its provisions would strain the resources of all the hospitals—public authority and voluntary hospitals—to breaking point. I do not think it can be contended that this is being done. Indeed, so far from there being any undue pressure upon certain classes of hospitals, we have reached a stage at which we have some hospital institutions vacant for want of patients, and our difficulty has been to find some use for them. That of course does not apply to general hospitals in Dublin, but I do not think it can be contended by any person going through the hospitals and looking at the conditions and the manner in which patients are treated now that the Health Act of 1953 imposed any undue strain upon their resources or their staff.
In any event, the raising of the income limit from £600 to £800 surely is not going to increase the incidence of sickness and illness among us. We will still have the same number of persons falling ill, I suppose, year after year, or approximately the same number. The only difference will be that if they do fall ill they will receive a certain amount of help to make themselves well. The voluntary hospitals will, to that extent, perhaps, benefit by the provisions of the Bill.
Senator O'Quigley was one of the Senators who raised a number of questions and were disturbed about the effect this Bill might have on the voluntary health insurance scheme. I have dealt with that and I do not think I need repeat what I said. Another question which he asked was whether the officers of local authorities are unduly meticulous in inquiring into the means of voluntary contributors under the social insurance scheme. I do not know. I do not think they are. Naturally they must satisfy themselves —they must do their duty to the ratepayers—that these voluntary contributors are entitled to secure services which are provided for them, either free of charge, or for the rather nominal charge which is provided for in the amending Act of last year.
Senator O'Brien said that the Act of 1953 was put through in the teeth of opposition from the medical profession. I do not know whether or not that is an exaggeration, but I do know that despite that opposition, the Government which in 1954 succeeded the Government which put the Act through in 1953—our immediate predecessors in office—put the whole Act into operation. They must have done that presumably by some sort of agreement or arrangement with the medical profession. In any event, since then, we have had another general election. The Health Act of 1953 happened to be one of the issues in that election, particularly in my own constituency, and the people have endorsed the provisions or the principles of the Health Act of 1953. It is too late to argue whether we are for or against the Act. The people have spoken in regard to it and we have just got to make the best of it and the medical profession must make the best of it.
The Senator also adopted an unaccustomed role. As a rule, he is one of those who plead for greater and greater retrenchment in relation to Government services and expenditure. To-night, he told us the health facilities are inadequate at the moment and he spoke of the real or alleged need for retrenchment. I think our general financial position may be somewhat better now than it was last year. The need for retrenchment, however, where it can be secured without affecting the efficiency of the services has not passed and, needless to say, it is still very real. To the extent that we can make these services more economical without impairing their efficacy, I shall try to do so; but I must say I cannot see that we will be in a better position greatly to increase the amount of money which can be provided for the health services, while still trying to meet the long term commitments of the Hospitals Trust Fund. The community as a whole is still bearing a very substantial burden in taxation. There are other sources of revenue which appear at the moment to be tending to dry up. In these circumstances we shall have to face the position realistically and see what can be done. We have done a great deal within the past five or six years and until the situation has considerably improved we cannot do very much more.