I move:
That Seanad Éireann approves the following regulations in draft—
Health Contributions (Yearly Reckonable Income) (Variation) Regulation, 1986
a copy of which regulations in draft was laid before the House on 27th February, 1986.
Health Contributions (Yearly Reckonable Income) (Variation) Regulation, 1986: Motion.
Subsection 3 of section 9 of the Health Contributions Act, 1979, provides that the Minister for Health may by regulations vary the income ceiling level which, taken in conjunction with the rate of health contributions applicable, determines the maximum amounts of contributions payable in respect of an individual in any particular contribution year. Subsection 5 of section 9 of the Act of 1979 requires that a draft of the proposed regulations shall be laid before each House of the Oireachtas and that the regulations shall not be made until a resolution approving of the draft regulations has been passed by each House. The draft regulations now before the House deal with the income ceiling which, it is proposed, shall apply in relation to the contribution year commencing on 6 April 1986. It is not proposed to vary the rate figure which has remained at 1 per cent since 6 April 1979.
The income ceiling is at present £13,000 and it is proposed to raise this to £14,000 with effect from 6 April 1986. In determining this, I have taken into account, as required by the Act, the latest information available regarding changes in the average earnings of workers in the transportable goods industries since the last income ceiling figure was adopted. The effect of the increased ceiling is to increase the maximum contribution payable from £130 to £140. However, the increase will fall to be paid only by persons whose income exceeds £13,000.
It is estimated that raising the ceiling level from £13,000 to £14,000 will result in an increase in the amount of contributions to be collected of approximately £2.1 million in the contribution year 1986-87. Of the estimated additional income, about £195,000 should arise in the calendar year 1986. The remainder of the additional yield should be paid over in the first quarter of 1987.
Regarding the eligibility level generally, I shall be reviewing shortly the income limit for free hospital consultants' services. I am not in a position as yet to say what this limit will be.
The Revenue Commissioners are now responsible for collecting current health contributions from all classes including the farming sector. Health boards remain responsible for the collection of arrears due from the farming sector for periods up to 6 April 1984. The total amount of health contributions owed to health boards at 31 July 1984 was £11.8 million. This amount was reduced to £9 million at 31 December 1985. I am most anxious that these arrears and indeed arrears due from other self-employed persons should be collected as soon as possible and help to relieve somewhat the very tight budgetary situation in which we are now. In the case of arrears due to health boards, I have advised health boards to make full use of every enforcement procedure available to them in the collection of outstanding amounts. In fact in recent months health boards have notified a number of defaulters of their intention to take legal action for the recovery of arrears. Solicitors' letters have issued and some boards have selected cases for proceedings if demands are not met.
Members are aware that in 1984 I introduced a regulation whereby any person who on admission to a public hospital bed fails to produce evidence of current payment of health contributions is liable for an additional charge of £100. So far 154 persons have had to meet this charge and I propose to amend this regulation shortly to increase this penalty to £150. I would stress that persons in arrears are not refused admission to hospital but the collection of the admission charge and arrears in pursued later.
As an added incentive to health boards to collect amounts outstanding, I made regulations last year, with the consent of the Minister for Finance, which provided that health boards could retain in full arrears of health contributions collected by them in 1985.
A total of £1.4 million health contributions arrears was collected by health boards in 1985. In the normal way these contributions would have been credited to the Exchequer. I wish to announce that I am extending this arrangement to cover all outstanding health contributions arrears collected by health boards in 1986 and future years. This decision will be of continued benefit to the health boards' budgets.
I now ask the House to approve of the Health Contributions (Yearly Reckonable Income) (Variation) Regulations, 1986, in draft.
I have often wondered why the amounts go up per £1,000. It was £13,000 last year and it was £12,000 the year before. I am sure it has something to do with the benefits that accrue. Perhaps the Minister might explain. He has indicated to us that the Revenue Commissioners are responsible for collecting the current health contributions from all classes including the farming sector. Up to recently the health boards were responsible for the collection of these amounts. The health boards remain responsible for the collection of arrears due from the farming sector for the period up to 6 April 1984. The health boards were very severely criticised for their failure to collect these funds. The Minister has indicated that this amount has now been reduced to £9 million. Health boards are making every effort possible to get in what money is due to them. It is important for them to get in as much money as possible. Now that the Revenue Commissioners have this responsibility, I would like to ask the Minister a few questions. Could he inform me how much has been collected by the Revenue Commissioners? What percentage of bills has been issued by the Revenue Commissioners? My information is that things are not going well and that the performance of the health boards might be a lot better in the area of collection than that of the Revenue Commissioners. What can be said now more than ever in our history is that given the very perilous position of the health boards, in which there are all kinds of cutbacks envisaged for the year ahead, not to mention what we have had over the past year such as closures, staff redundancies and so on, obviously any more money that can be brought into the service and passed on to the health boards would be to the advantage of all.
In agreeing to this regulation for which the Minister has asked approval I await with great interest the replies to both of my questions. One wants to know how much has been collected by the Revenue Commissioners since they were given this task, and, secondly, what percentage of bills have been issued by the Revenue Commissioners to get in this money that is so vital to the health service.
I would like to make a suggestion to the Minister that, when these notices appear on the paper that the limit has gone from £13,000 to £14,000, the benefits that are available to people would be highlighted so that people would know what exactly is available to them and why they might be paying extra money.
I would like also to mention the money that is owed. We are building up a myth that becomes a bigger myth each year as to what is owed by different people. I know, and I know many people in the Seanad know, that bills that are sent out to farmers as a result of income tax assessment and used by the health board bear no relation to reality. I have seen bills sent out to farmers simply because they have not made returns. It is estimated what in theory they should be earning. I have questioned my own health board as to how real their estimates are. I think there was over £3 million owed by farmers to the South Eastern Health Board over a number of years. The reality I believe is that maybe only half of that is owed. We could be fooling ourselves in talking about this money that is owed by people. It is quoted by trade unionists and by people who object to paying tax; they say you should collect what is owed.
It becomes a bigger problem the more often we put it in print or announce that millions of pounds are owed by certain people. If it is owed, the money should be collected but if these are estimates then we are only fooling ourselves into thinking that we have money there waiting to come in when in actual fact it is not there at all. I would worry that we might add to the myth that exists that there is money owed right, left and centre by farmers. There are farmers who owe money without question but I do not think, from my own experience in dealing with farmers who have got bills, that the money that appears to be owed is actually owed at all.
The draft regulations which are before the House propose to raise the income ceiling for health contributions from £13,000 to £14,000 with effect from the beginning of the next contribution year, which is 6 April. When these regulations are approved the maximum health contribution will increase from £130 to £140. The increase involved is in excess of 7½ per cent. It is well above the percentage increase in earnings of most workers since the present income ceiling was fixed this time last year. As far as the vast majority of farmers are concerned, not alone did their incomes not increase but in many cases they suffered a considerable reduction due mainly to the losses caused by the disastrous weather conditions of 1985. It is also hard to see how the Minister can justify increasing health contributions when one considers the serious cut-backs in services which have occurred over the past 12 months. Staffing levels have been reduced and waiting lists are growing longer day by day. The regrettable fact is that many services such as dental, opthalmic and orthopaedic services have ground to a halt in most health board areas. However, I suppose that anybody who is in category two for health services and has got to go to hospital gets good value for the amount paid in health contributions.
One of the reasons there are so many problems with the collection of health contributions from farmers and other self-employed persons is that many people are not aware of what their entitlements are. There is also a good deal of confusion about the method of assessment. That confusion is compounded in the case of persons with more than one income, such as part-time farmers. The fact that they were also liable in the past to other levies, and will continue to be liable for the youth employment levy, has added to the confusion. A greater effort should be made to inform people of the regulations governing these levies and of the method of assessment.
In the case of health contributions it is very important to make people aware of what their entitlements are, if they are in this category. If people are convinced that they are getting good value for money they are much more likely to pay up. I understand that at present asessments for health contributions are being issued by the Revenue Commissioners to farmers and to the self-employed. I would be interested in hearing the Minister's reply to the questions raised by Senator Fallon in relation to the number of bills which have been issued and the amounts that have been collected to date. I am informed that people who are receiving bills for health contributions at present are being told that they have no option but to pay the amount demanded, even though they are satisfied that the assessments are based on notional income figures which have no relation to actual income figures. It has been pointed out, of course, that any overpayment involved will be credited or refunded to them in due course when actual income figures have been agreed.
If this is the situation, I believe the system should be changed. I do not believe this is the way to get co-operation or prompt payment. People should have the option of paying a portion of the levy on account and the balance when actual income figures are agreed. As a further incentive to people to pay their health contributions it might be worth looking at a system whereby hospital services cards or application forms for hospital services cards would be issued automatically to people who have paid the previous year's health contributions. Also, a brochure outlining their entitlements should be issued to them. At present when people pay their health contributions they are issued with receipts, and nothing else. If a person wishes to obtain a hospital services card it is necessary to obtain an application form from the health board office, complete it and return it with the required evidence of income. I accept that there are leaflets available in the health board office which provide a summary of entitlements but most people never see these and have no idea of their entitlements neither are they clear on the method of assessment.
I also believe that it is true to say that very few people apply for hospital services cards although they are entitled to them. One of the reasons for this is that they have no idea where to apply to or how to apply. If they have to go into hospital they are in a state of panic because they have no hospital services card. They fear they will be faced with huge bills for hospital and consultant services. The majority of people who are entitled to category two services do not realise that they are so entitled. Consequently, they worry unnecessarily about the possibility of being faced with bills for hospital expenses. I am sure that every public representative, and every Member of the Seanad, has at some time seen the look of relief on a person's face who has just been told that there is no need to worry because there will be no bill from the hospital or no bill for consultants' fees.
I want to appeal to the Minister to look for ways and means of providing better information to people who are liable for health contributions on what their entitlements are, what the method of assessment is and what the procedure is for those who wish to obtain a hospital services card. The second plea I want to make to the Minister is on behalf of people whose medical cards have been withdrawn. For the past 12 months in the Western Health Board area — and I am sure the same applies to other health board areas — there has been an ongoing intensive review of medical card eligibility. Hundreds of families have had their medical cards withdrawn. In many cases the medical cards have been withdrawn although the income of the family was only marginally in excess of the guidelines. The withdrawal of medical cards in such cases is causing great hardship.
A medical card entitles the holder and his or her dependants to full eligibility for health services; it entitles them to general practitioner services free of charge, to in-patient services in public wards and specialist services in out-patient clinics. It also entitles them to dental, opthalmic and oral services and also free prescribed drugs and medicines. A medical card also determines eligibility for other benefits, such as free school transport and assistance under the free book scheme, as well as entitling the holder to relief in the case of employees PRSI and exemption from other levies such as the youth employment levy and health contributions. However, when a person's medical card is withdrawn he or she is immediately liable for health contributions as well as being ineligible for all the other reliefs to which I have referred.
Therefore, a person whose income marginally or significantly exceeds the guidelines, and whose medical card is withdrawn, may finish up considerably worse off than someone whose income is marginally within the guidelines and who has a medical card. For example, if the relevant guidelines for two individuals — let us call them "A" and "B"— are £120 a week and "A" has an income of £130 a week and "B" has an income of £110 a week, "B" retains his medical card while "A's" card is withdrawn. "A" is then liable to pay health contributions, youth employment levy, full PRSI, GP's fees, up to £28 per month for prescribed drugs and medicines. His family are no longer eligible for the free school transport service or assistance under the free books scheme. The result is that "A" finishes up considerably worse off than "B". I hope the Minister sees the point I am trying to make, that the withdrawal of a medical card can have traumatic consequences for a family.
The anomalies which exist are even more obvious when one compares the case of a wage earner with that of a person in receipt of social welfare benefit. In the case of all wage earners the guidelines refer to gross income, but a social welfare payment is a net payment and not liable to any deductions. Similarly, farmers are assessed on net income rather than on gross income. Therefore, in my view there is discrimination against the wage earners. I believe that the wage earner should also be assessed on net income, that is, on the amount per week which he gets into his hand. Take the case of a wage earner whose medical card is withdrawn because his gross income exceeds the guidelines, while a social welfare recipient retains his medical card because his income is within the guidelines, even though the net value of the wage earner's income after deductions is less than the amount of the social welfare payment which the other person receives. These anomalies should be eliminated. Also, there should be a mechanism built into the system to ensure that the withdrawal of medical cards from persons marginally in excess of the guidelines would not have such serious and far-reaching consequences for the person and the families involved.
Perhaps we have reached the stage when we should be considering dividing category 1 into subcategories with different degrees of eligibility. For instance, there could be one subcategory of persons who would have full eligibility for all services and who would be entitled to all the other benefits and exemptions to which I have referred. Another subcategory could cover persons who would have full eligibility for medical services and, perhaps, be eligible for some other benefits. Another subcategory could cover persons with full eligibility for medical services but who would not be eligible for any of the other benefits or exemptions. It might be possible to consider another subcategory where persons would have full eligibility for medical services but would be liable to health contributions or some charge in respect of those services. A change, such as I have suggested, might have some administrative difficulties but it certainly would go some way towards overcoming the problems and anomalies to which I have referred.
I also wish to refer to an anomaly which exists in the case of persons with category 2 eligibility. When the Minister fixes the income ceiling for category 2 eligibility persons under the ceiling will be eligible and persons over the ceiling will not be eligible. In the case of married persons the incomes of both spouses are assessed separately. Therefore, if the income ceiling is £13,500, as at present, a person with £13,000 income per annum is eligible and a person with £14,000 per annum is not eligible. However, the person with £13,000 per annum may have a spouse earning £13,000 more. That does not affect their eligibility. Therefore, one could have a situation where two families could be living side by side one a single-income family with an income of £14,000 and therefore outside the scope of category 1, while the two-income family would have a combined income of £26,000 and be eligible for category 2 services. For the purposes of category 2 eligibility 50 per cent of the income should be put against the non-income earning spouse, or an allowance should be provided in respect of the non-income earning spouse and the dependants. Otherwise, the single-income family is being discriminated against, as is the spouse who works in the home. I would urge the Minister, when fixing the income limit for category 2 eligibility, to consider the points I have raised with a view to eliminating some of the anomalies.
I welcome the move to vary the health contributions. I appreciate this decision. It would be a mistake not to have regard to what has been happening in the total area of health, having regard to the amount of arrears referred to in the Minister's speech. Nine million pounds is a very substantial amount of money. If one adds to that the additional self-employed contributions still outstanding, we are talking about a lot of money. We are in the position of arguing about the neglected areas and social groups, not just the people who are going to be eligible to pay more.
The position is that the standard of health differs between classes and between regions. The prospects of good health are significantly worse for the children of unskilled workers, and of manual workers in particular. That is the position throughout their lives. Down through the years there has been a greater mortality rate in infancy in that particular category. They spend a shorter period of time at school. There is some social neglect. When they begin work they have to work longer and they have longer spells of sickness. People who are manual workers are more likely to be admitted to mental hospitals as they grow old. In their old age they are more likely to suffer from chronic bronchitis and so on. Inevitably they die younger than better-off people. In the areas I have mentioned the situation has been worse, healthwise, for many people from the cradle to the grave. Therefore, when we talk about £9 million being owed by any category, whether farmers, self-employed or anybody else, we are talking about money that could do a great deal in the health area. This has a relevance to the increased level of health contributions eligibility.
If my views are to be either substantiated or contradicted, it will take a working party, not just someone looking at certain aspects, but a working party actually looking at the aspects of society of which I have spoken. I am confident, having regard to St. Vincent de Paul reports and so on, that I will not be contradicted.
It is necessary to say very bluntly that standards in health services are related to class. The whole question of access to the health services needs remedy. When I talk about social neglect it must be said that housing may be the cause of some of the problems. Social security must be kept to its proper level. These must operate together with the health services and access to such services. If one person can get access to a consultant more quickly than another who does not pay, then there is something wrong with the system. If the money was there to be redistributed some attention could be given to these problems. It is very hard not to look at it from the point of view of class. This is not because one wants to be ideological or anything else. One has to think in terms of change itself. Within the meaning of the health services, the Minister has been persistent. He went about changing the system very diligently and has done a great deal to try to effect change. He has been very tenacious in pursuing his objective. I hope that at the end of the day by pursuing his objective in this way the social neglect I have spoken about will be made a little bit less acute. It certainly is not going to remedy it, but at least it is a step in the right direction.
In general it would be correct to say that the Minister is going the right way about redressing the balance. I am not so sure that he will be able to do it in his lifetime. However, it would be hyprocritical of me if I did not say that, while I admire what the Minister is doing I notice, when I am talking in a pub or somewhere else, that once something is printed in the media it looks terrible, but once it is explained by the Minister on the radio or on television most people accept that many of the things the Minister is doing are not only necessary but are the right things to do. But I would be less than fair if I did not say that his approach seems to some people to be insensitive and may cause mental anguish. I do not believe the Minister sets out to do that. That has been the result of recent situations. On the other hand, if his approach could match his competence and his courage, I dare say that he would go down in history as probably the best Minister in the Department of Health since the foundation of the State. It is a delicate area. I do not want to go too deeply into it. I do not think it is irrelevant to the question of health contributions. We are talking about people having to pay more money for the health service. We are talking about the social neglect that is caused, from the Minister's own observations, by the arrears.
We will take now the question of health contributions and speak of specialist care. On the question of class, the people I spoke about at the beginning are going to have less chance of specialist care unless something very radical is done. Perhaps they will get it eventually, but I do not think they are going to get it before some considerable time has elapsed. Senator Mullooly mentioned the long waiting lists. Perhaps some of the savings to be made by some of the means which the Minister mentioned, coupled with the collection of arrears, will bring about some desirable effect.
I do not know if it is possible in toto to examine the question of redistribution in such a way that one class will not eventually still remain a little bit better than the other. But the balance can be redressed to a great extent. This is why I admire the Minister's tenacity of going after certain things in certain areas. There is always the danger, in approaching change, that the whole question of redistribution from the poor to the very poor will result rather than redistribution from the better-off to the poor. This is what can happen if the problem is not tackled properly. This usually happens. I am trying to explain that the money collected in arrears, and other moneys saved through certain rationalisation programmes, can end up in a situation where the poor actually help the poor, unless the situation is handled properly. That is the way it has been for a long time. The redistribution, rather than going from the people who can afford it in the health services, may not take place. The moneys may go from the poor to the very poor. That is something the Minister should probably have in the back of his mind. I do not think he has to be reminded too much by me about a situation like that.
Obviously, sufficient funds to bring about this necessary adjustment in the balance between the classes in the area of health must be there. Since our economic situation is drastic, I can understand the Minister's diligence in going after the arrears. At the same time the question of a balance comes in. How is it done? Perhaps I am trying to back two horses but I would be rather concerned with the human side of the whole process. I would be worried about the staff situation. I know that consultants are good people. Eligibility to their services is a good thing. But, unless there is the provision of more staff where it is needed, either in health centres or hospitals, we will have missed out in the purpose of what the Minister was aiming at.
The whole question of long waiting lists is something that Senator Mullooly mentioned. There is still much evidence of that. The position is that they may have shortened somewhat over the last couple of years. I have not got the information now but I know a couple of years ago there were very long lists. I just happened to be in hospital six times myself in one particular year. That is how I can speak in that way. The fact of having to wait is not so bad. The worst thing of all is there are certain conditions such as hip operations which are quite serious. The pain is severe. It is not only a question of waiting but it is a question of waiting in pain. That is the problem. How does one deal with it? One has to have some sort of periodic drive to shorten the time of stay in hospital after other operations and in other types of sickness. For example, the waiting lists are not organised well. They could be planned better than they are at the moment. One of my operations was to deal with varicose veins in both legs. All I did while in hospital, was walk around the hospital strengthening my legs. I could have done that at home or anywhere else. I am just giving that as an illustration. Possibly there could be a tightening-up in this area where there are people staying in hospital with complaints that should not necessitate long stays. Other small operations, such as hernia operations, should not take as long in hospital as the more major operations.
The planning of the intake of patients and the periods in hospital with certain types of problems and operations seem related to a person's social class. Having to wait for indefinite periods, either to see consultants or to find a place in the hospital to deal with the problem, seems to be related to a certain class, but they are a certain class in pain. My experience was that it was not unknown for people to have to wait 18 months. Then a problem arises after the 18 months when one gets three days' notice to come into hospital. People could jump the waiting lists because they could go through private treatment.
When dealing with the question of planned intake of patients, this whole question will have to be looked at as well. For example, there are areas where people cannot be rushed — for example, plastic surgery and possibly the question of the hip replacement. There are not enough people available to do those things and they could not be planned in the same way as you could plan the small ones. But it is a novel idea that they tried in England on one occasion. For example, we could just deal with the normal things in an emergency situation and then set aside one week for dealing with hernias, for example. It might be possible to do things like that. It might be possible also to have a look at the operating theatre wards where more intensive use could be made of the facilities and thus reduce the stay.
I should like to wind up by saying that I welcome this. I am keen on this planned admission. One of the difficulties I see with it, when getting down to the question of notifying people who come in, is that if they are only being given three days' notice there is a great possibility that they have been waiting for 18 months, that they will not be able to drop what they are doing at that particular time or to make the necessary home arrangements. Consequently, what will happen is that there will be a certain percentage who will not turn up to take their bed, or they will opt out of the whole idea if they are not in too much pain and put it off for another day.
It is something that concerns me. I should like to see the money that is available, money that is owing, money that is saved as a result of the activity of the Minister supported by the Government, being put to some sort of use and to try to make the problems, particularly of the families of manual workers, less acute, so that they will not have to wait these very long periods.
I welcome the opportunity to make a few observations about these regulations. The result of increasing the ceiling from £13,000 to £14,000 would mean that more money would be collected from these contributions. The Minister stated that this would be approximately £2.1 million in the contribution year 1986-87. This is a considerable amount, I suppose. I should like to refer, in passing, to the increase of £1,000. Senator Mullooly referred to this. Over the past few years the increase has been £1,000 each year. I am quite sure that in making the increase the Minister kept strictly to the regulations.
Another welcome result of this increase is that those with incomes under £14,000 will qualify for hospital services cards. Of course, we would all like to see the rate of 1 per cent being reduced. Since 6 April 1984 the Revenue Commissioners have taken over the responsibility for collection of health contributions from farmers as they were already doing for the PRSI workers and the self-employed. It is right that it should not be the function of the health boards to do this. But, nevertheless, the health boards were left with the problem of collecting the arrears.
I should like to refer briefly to the farmers, as other Senators have done. The method of calculation used to be the valuation multiplied by a certain figure. This was the situation until the court in Wexford; it was discontinued after that verdict. The health boards had to go on the income basis. This was simple enough, I believe, for people whose valuation was over £40, because the figures were available from the Revenue Commissioners. But where the valuation was under £40 the health boards wrote out to farmers for their income, and I believe many of them made a genuine and reasonable attempt to try to arrive at the right figure. The bills were sent from the health boards in respect of that. Some returns, it was suggested, bordered on the crazy and the health boards had to do their own assessment. Of course, some did not reply. The result was that the health boards had to estimate the income. This gave rise to some problems.
The North Eastern Health Board, in the area from which I come, estimates that the balance due from farmers at 31 December last year was £1.4 million. The longer it goes the more difficult it will be to collect this figure. In the interim period two bills have already been received from the Revenue Commissioners. It is fair to say that farmers are willing to pay and co-operate if the collectors call for the outstanding accounts. This has been proved in the North Eastern Health Board region. People call to collect the accounts. They can talk to the farmers instead of sending out pieces of paper, bills which are meaningless. The farmers were used to the rate collectors and that system of collecting outstanding accounts at the most suitable times and of course the rate collectors called after fairs and markets. In that system the farmers paid their way.
The Minister made a decision last year that the money collected would be used by the health boards and kept for their own use. This was very welcome. I welcome his announcement today that he will continue this for the present year and for future years. This has helped in many areas to prevent a bad situation from becoming worse. In the North Eastern Health Board region for Cavan-Monaghan and Louth £170,000 was collected last year.
With regard to the land tax, when the £10 per adjusted acre comes into operation I believe that no decision has been made on determining the method of liability. As Meath is one of the areas where the land tax will come into operation at an early stage, I should like to know what the situation is in that regard.
Finally, I want to refer to an anomaly and a situation where the Minister might, after mature consideration, make some changes which I think are desirable. This is where third level students are involved. The only students at third level entitled to medical cards are, I believe, students whose parents are entitled to medical cards. A person out of the same family doing an AnCO course living at home with the equivalent money is entitled to a medical card because that person is assessed on his own as an income apparently and not part of the family. I think there are many people who genuinely feel that all students over 18 years of age should be entitled to a medical card. There would be very little cost involved on the part of the State. These people are for the most part healthy. There could be a situation where a not so well off family might have one, two or three children attending third level education. That family would be in a very difficult situation. So I would like the Minister to investigate the possibility of changing this anomaly.
I should like to welcome the measures outlined in the Order. The whole question of charges is always an emotive one. As long as it is directly linked to ability to pay, I have no objection good, bad or indifferent to charge. Indeed, I support charges and the principle of people being asked to pay for services — water services, refuse collection services, etc. As long as you have a safety net there, such as applies in the case of local authority charges of the right of water, the discretionary right in cases of undue hardship to do so and so long as the system outlined in this order is based on the ability to pay, then I see absolutely nothing wrong with it and in my opinion it is most commendable.
We own apologies, in fact, to nobody for supporting the measure as laid down here when you consider the vast amount that is available under the health service, the vast labyrinth of services available and the high standard of care and service provided throughout the whole realm of the public health service. I would, however, agree with Senator Browne in relation to the cutting of the stick to beat ourselves. That is the usage at times of mythical figures in relation to what is and what is not owed. There is no question that very often we are given, and we give ourselves, inflated figures in relation to the amount of outstanding debts in the whole area of taxation and in relation to the whole area of service charges and health charges.
I agree that there is a colossal amount yet to be collected. I do not accept that the figure is always the figure that is thrown out. Very often, while farmers are somewhat to blame in that there is an initial tendency to throw into the fire the first demand that comes — and perhaps the second one — in the hope that it will go away and be forgotten about, nevertheless, people fail to appreciate that by filling them in by pitching their income levels at realistic levels they will be saving themselves a lot of hassle and hardship and a lot of worrying and anxiety that frequently comes to bear on them.
On the other hand, there is a failure on the part of the authorities to take into consideration a lot of the nitty gritty and the elements that go into making up a farm income, particularly in relation to recognising the number of items that go into the making of a farm income by way of expenses necessarily incurred in the earning of that income. All of the outlays should be taken into consideration. I am totally opposed to national assessments on any basis. I think it is wrong, and it very often gives an inflated and grossly exaggerated income figure in relation to what peoples' actual net incomes are.
I can see a certain amount of merit in the suggestion of Senator Fitzsimons, that is, the idea that collectors might be more efficient. On the other hand, I think that there is an aura and an air of the bailiff in relation to somebody knocking on one's door to collect any charges, in that one often associates the arrival of the rate collector with the executive functions that pertain to the rate collector, that is, the eviction process in the event of somebody not being able to pay.
I would agree with the point made by Senator Browne, that is, that if we could at all times try to bring before people, and spell out in clear, precise detail, the enormous number of entitlements they have, if they pay this charge, by way of the provision of free hospital care services in public hospitals, etc, I believe we would do an awful lot to alleviate peoples' anxieties and to extract the money that we see here pitched at a reduced figure of £9 million. I think that every time a bill or a demand goes out to somebody affixed to that should be, spelled out in clear detail, the entitlements to which these people are entitled in the event of their making payment and when they make payment. I think that if the point made by Senator Mullooly were implemented — that is, that if there were some form of service card, hospital services card, etc rather than just an acknowledgement or a receipt in the event of payment, would help again to spell out to people the magnitude of the services they are being given and the high quality and standard of services they are gaining if, in fact, they pay the charges levied upon them.
I would like to take very briefly a point made by Senator Mullooly. We are talking about efficient running of the health service here. We have been talking over the years, indeed, we are grey in the face talking about areas where, in fact, economies could be effected. There is one stark example which was alluded to and touched on by Senator Mullooly. That is the operation of assessment in relation to medical cards. I appreciate that there has to be assessment. I have asked, in fact, for a factual assessment. What I am asking for is that the emphasis be put on the word "factual". I have come across numerous cases that operate in the Western Health Board area in particular where somebody is assessed for his entitlement of unemployment assistance. A social welfare officer comes out. He visits the man in situ. He sees the situation on the ground. He arrives at a figure of income, we will say £25, and on the basis of that £25 the man is determined to be entitled to something in the region of £65 unemployment assistance. That would bring the man's total income, for a man, wife and two children, to £90. That has been factually determined, professionally assessed by a social welfare officer.
The following week the man applies for a medical card. He goes into the local community welfare officer and he is asked to send on some documentation to the local office. No figure of income arrives back. What happens, in fact, is that the man is told that on the basis of means you are determined to be ineligible for a medical card. Yet you have a community welfare officer contradicting social welfare officers' assessments the week before that. It has been said to me by people on the ground that one, in fact, is making a liar of the other in relation to the method of assessment being used and the final income figure. I have come across, time and time again, variations as great as £40 and £50 in the assessments carried out one week by a social welfare officer and the other week by a community welfare officer. Apart altogether from the wastage of resources here, I believe that it leaves people bewildered and sour and angry. I would ask the Minister to instruct the health boards that, where a social welfare officer determines a person's income having professionally assessed it, having examined all the minutiae that goes into the making up farm income that, in fact, should be the norm. It should be automatically acceptable and accepted as the basis of somebody's determination of income rather than having the regurgitation of it again and somebody the following week, another officer of the same rank in a different Department, arriving at a vastly different conclusion.
The final point I should like to make is that the business of making big money available which is collected and given to the health boards is an excellent idea. It does provide an element of incentive. It is something that should be encouraged. It is something I should like to see extended in the area of road tax, for example, that the taxation that comes from motor cars would be applied to the county within which it is collected. It goes a long way, in my opinion in giving the health boards the necessary incentive to go about the application of their duties.
I should like to congratulate the Minister on the manner in which he has performed his duties as Minister for Health. I believe he is a pragmatic, realistic Minister. I believe that he has shown the necessary compassion and that very often he is misrepresented. I believe he is one of the most maligned members of the Cabinet and very often he has been put down as the bête noire of this particular Cabinet. In my opinion most of the decisions he has taken are not alone defensible but commendable. When they are done in the interest and welfare of the patient I think the ultimate benefit will eventually percolate and shine through.
I should like to thank Senators for their understanding and contributions to this debate. Senator Fallon asked the precise level of current contributions being accumulated under the Revenue Commissioners' system. I do not have the particular details. I will endeavour to get them for the Senator because, as the Senator is aware, the health boards at this stage are dealing only with the arrears of contributions. Of course, there is the transitional arrangement relating to the land tax as such. I can only give that much information at this point in time.
Regarding the general level of contributions, we should take note that, whereas we have succeeded in collecting some £2.8 million of arrears from the farming community between the middle of 1984 and the end of 1985, that brings the arrears — admittedly, it is a somewhat national figure — to around £9 million. Nevertheless, it has gone down from £11.8 million to £9 million now, and I think there is a substantial amount of money available there. That money goes directly to the health boards. At local level when the officers of the health boards point out to those who owe the money that the money is being used currently by the health boards from 1985 onwards and for 1986 and 1987 onwards in terms of any arrears due, people may be more amenable to pay.
There is still no doubt that, no matter what way one examines it, there are two outstanding factors in relation to health contributions. The contributions are minimal. We spent £1,273 million this year. The totality of all health contributions will amount this year to only £78,500,000. The contribution is 5 per cent or thereabouts of total income. The balance of the money comes from the general Exchequer and from general taxation. God be with the days when we all remember in this House arguing about health charges at local level. These have been abolished. Everything is now loaded on to the central Exchequer and in time all hell breaks loose vis-a-vis the budgeting by the central Exchequer for all of these services.
The second general point I would like to make is that health contributions are paid for any insured workers. The contributions from the other sectors are marginal. They are so small that one should not at times be arguing about them. I will give the House the simple facts. In 1983 insured persons paid £62,500,000 in health contributions. The farming community paid £.7 million. Other self-employed persons paid £2.6 million. In 1984 the contributions were £65.8 million from the PAYE sector. The farming community paid £2.3 million that year because of a change in the arrangements and last year PAYE insured persons paid £73.2 million and, with the transitional arrangements, the farming community went down to £1.6 million and the other self-employed people paid £2.4 million. I took out a rather interesting figure. Since 1971-72, £435 million had been paid by insured persons in health contributions. That is up to the end of 1985; the farming community, £21 million. That is £435 million versus £21 million and others, that is, self-employed, £18 million. We took in in all of that period, 1971-72 up to the end of 1985, £472 million in health contributions and of the £472 million insured persons paid £435 million.
For all practical purposes health contributions are paid by the urban community. I make that broad point. That is what gives rise to a great deal of understandable reaction from so many people in terms of who is paying for what.
We are reviewing the limit of £13,500 for category 2 eligibility at present. It will be increased with effect from 1 June 1986. That will refer to income for the year ended 5 April 1986. Because it is 5 April 1986 it is not possible at this stage to estimate the figure correctly. We will have it shortly and we will be making an announcement in the near future.
I take the point made by Senators in relation to assessment. We urgently need uniform methods of assessment, and I take the point in relation to social welfare assessments for factual assessment there and for factual assessment in terms of health eligibility for general medical services. I share that point and I am acutely aware of it in terms of the multiplicity of assessment methods available. It is something I would hope from the Commission on Social Welfare and from the health side that we will rationalise effectively so that people will not be driven to distraction by a multiplicity of means test methods in force. These are the two points I want to make in reply to Senators and I commend the regulations to the House.
Question put and agreed to.