Dáil Éireann díospóireacht -
Wednesday, 6 Nov 1929

Vol. 32 No. 6

Public Business. - National Health Insurance Bill, 1929—Money Resolution.

The Dáil went into Committee on Finance.

Minister for Local Government and Public Health (General Mulcahy)

I move:—

Chun críche aon Achta a rithfar sa tSiosón so chun na hAchtanna um Arachas Sláinte Náisiúnta, 1911 go 1928, do leasú, go bhfuil sé oiriúnach a údarú go n-íocfar amach as airgead a sholáthróidh an tOireachtas, (a) síntiuisí in aghaidh costais aon íocaíochtaí a híocfar i dtaobh socair phósta fén Acht san, (b) suim bhliantúil de £27,750 chun a roinnte ar chomhairlí contaethe agus contae-bhuirgí do réir forálacha an Achta san, (c) pé suimeanna is leor, i dteanta na suimeanna eile a hordófar leis an Acht san a chur i gereidiúint don Chiste Liaigh-Dheimhniúcháin, chun íoctha na suimeanna a hordófar leis an Acht san d'íoc amach as an gCiste sin, (d) an costas a bhainfidh le hAthbharúla Dochtúra d'fháil fén Acht san, agus (e) aon chostaisí eile fé n-a raghfar chun an tAcht san do chur in éifeacht.

That for the purpose of any Act of the present Session to amend the National Health Insurance Acts, 1911 to 1928; it is expedient to authorise the payment out of moneys to be provided by the Oireachtas of (a) contributions towards the cost of any payments made in respect of marriage benefit under such Act, (b) an annual sum of £27,750 for distribution among the councils of counties and county boroughs in accordance with the provisions of such Act, (c) such sums as, together with the other sums directed by such Act to be credited to the Medical Certification Fund, shall be sufficient to meet the sums directed by such Act to be paid out of the said Fund, (d) the cost of obtaining Second Medical Opinions under such Act, and (e) any other expenses incurred in carrying such Act into effect."

Mr. O'Kelly

I was told to-day that the amendment down in my name, No. 21 and amendment No. 20 in the name of Deputy Coburn to Section 24 of the Bill would be affected by the passage of this Money Resolution. I do not know whether or not it would be in order to raise this matter on this Money Resolution now.

An Leas-Cheann Comhairle

The Deputy can make his point upon the Money Resolution.

Mr. O'Kelly

I presume, from what I was told, that if the Money Resolution were passed we would be deprived of our opportunity of moving amendments 20 and 21 to Section 24, dealing with the moneys for medical certification. I take it that that is correct?

An Leas-Cheann Comhairle

Yes.

Mr. O'Kelly

My object in putting down my amendment was to preserve the funds that Section 24 now proposes to take for medical certification to the approved societies and, consequently, to allow them to remain available for the benefit of the insured persons. Section 24 proposes: "There shall be debited to the benefit fund of every approved society in respect of each member (not being a serving soldier) of such society the sum of fivepence for the year 1929 and the sum of two shillings for the year 1930 and for every succeeding year," and so on.

Now it was heretofore the practice that the State provided payment for medical certification. It is now proposed that the finances of the society are to be used for that, and that 2/- per insured person per annum will be deducted for that purpose. I think that is a wrong on the insured person. I think that the adoption of medical certification as a principle under this Act has not proved satisfactory and that neither the societies nor even the members will get value for the 2/- per head per annum that is being charged. I think it is well agreed that the medical certification system has not worked well; that there have been abuses. It is fairly well known that certificates are pretty frequently issued when the medical practitioner has not seen the person for whom he has given the certificate over a long period. Cases have been reported to me where a doctor has left to his maid or to somebody else in the house a number of certificates with instructions that "If so-and-so calls for a certificate you can give it to him." Numbers of these certificates are left there to be called for by people who went to obtain them in order to get continuing medical benefit. That is not a good system. In principle, it is wrong that the doctor should be paid by the number of certificates issued. Doctors, like everybody else, are human. If they can avoid extra work, they like to do so. Some are more soft-hearted than others and very free in giving certificates. They claim it saves time and bother and that it is a great convenience to the insured person. I believe it is a wrong principle. Some other means more effective in dealing with malingering could be adopted and it would be better for the insured person. Some of them have consciences and can be reminded of the fact that it is not right to get certificates in that way. Such doctors —I am not saying all doctors are like that—as do act in that too generous way ought to be reminded that it is not proper.

I know that letters have been issued by the Insurance Commissioners pointing out that abuses have arisen in connection with this matter. The medical certifiers in the Free State have been notified, and individual doctors have had their attention called to the fact that too many certificates are issued, and that when these cases were reviewed by other doctors it was proved that 50 per cent. nearly of the total that got certificates regularly could not prove they were unable to work. Therefore, it seems to me that the system is wrong. Representations have been made, I am sure, to every member of the House by the Association of Approved Societies and the Association of Trade Union Approved Societies on this matter. I feel—perhaps it is a strong term to use, but I think it is a correct term to use— that this is robbing the funds that ought to be left for the benefit of the insured persons. It is taking moneys that they have paid for the purpose of getting insurance treatment, and they are not really getting the medical benefit they ought to get.

An Ceann Comhairle

resumed the Chair.

Mr. O'Kelly

Of course it is useful to them, I know, to get certificates, especially when some of them are able to get them very easily. But the system is bad, and some other method ought to be adopted, and it was with that purpose in view that I moved the amendment.

Mr. P. Hogan (Clare):

To my mind there is a good deal wrong with the measure that the Minister is introducing, a good deal that might be plain to the Minister himself and to anyone who has had any experience of insurance administration in this country. First of all, I want to say that the method the Minister has adopted of dealing with this Bill in Committee is not a desirable one. National Health Insurance is a purely technical matter, very technical to a good many Deputies who might, in ordinary circumstances, be sitting in this Chamber. It is a very technical matter to most of them, and I think that a special committee of the Dáil would be the proper way to have dealt with this Bill. I thought that probably the Minister might have adopted that line and taken the Bill before a special committee. What I take particular exception to is the method by which it is proposed to recoup the medical certification fund—that is to say, the method by which the Minister proposes to take moneys away from the subscribed funds of members of societies in order to recoup medical insurance certification. I want Deputies to realise that no attempt whatever is made in the Bill to give anything for medical certification. The only pill that the Minister administers in this medical provision is the pill of taking money from the sick people and from the societies.

The history of medical certification is, in itself, somewhat interesting. When the British Government of happy or unhappy memory was responsible for the administration of National Health Insurance in this country they gave £60,000 towards medical certification, and the first act of a free people in this country was to drop a grant such as that of £60,000 or something like it. Now we find that the £45,000 that it is probably proposed to put up for medical certification alone is not to be got from the approved societies in the fashion that it was got before, that is, from the fund made up of unclaimed stamps, but rather that it is to be got by taking it away from the money set aside for sanatorium treatment. The Minister is Minister for Local Government and Public Health. I dare say that one of the functions of the Minister is to read a good many reports such, for instance, as the minutes of board of health meetings and documents of that kind. I want to say without any disparagement of the Minister— I hope he will accept it in the spirit in which I say it—that he has not had much experience of the actual operations of board of health meetings. He does not know the hundred and one difficulties that they come up against or the multifarious duties that they have to carry out, beyond probably a theoretical knowledge of it. He has no practical experience of it.

I put it to the Minister that the giving to these people of a grant of £27,000 odd is not the proper way to administer sanatorium treatment. I also put it to the Minister that when members of the board of health have disposed of the work that comes before them, work relating to cottages, sanitation, hospitals, the appointment of doctors and nurses, matters relating to water supplies and other things, that they will not be able to give to the proper administration of sanatorium treatment the attention it requires. If we are going to recoup the administration funds of certain societies by 5d. per head, and if it is necessary to do that, then I think it should be done in some other fashion besides taking it from the money that has been set aside for sanatorium treatment. I suppose we will have another opportunity of dealing with this matter when the sections come up for consideration. For that reason I do not want to delay very much further on the matter, except to register my definite opinion that the Minister, from two angles, is, in my judgment, dealing in a very injudicious fashion with this question of National Health Insurance. He has put before the House a measure that, for the average Deputy, is highly technical. I submit that he should take it before a special committee and have it dealt with fully and adequately before that committee. In the second place, not alone has the Minister and his colleagues in office dropped the £60,000 that was given by the British Government for medical certification in this country, but he is imposing upon insured persons, by taking away from them what they were getting for sanatorium treatment, a burden that it is not fair to put upon them.

Professor Alton

I would like the Minister to clear up the point raised by Deputy Hogan, and on the Second Reading of the Bill by Deputy Dr. Hennessy. It is a question that is creating considerable alarm amongst people in the approved societies— the question that no provision is being made in the Bill for the free sanatorium treatment that hitherto was given either by approved societies or by boards of health. I have had conversations with some people who were interested in this matter. They would like the Minister to explain what his views are, and to say how he proposes to provide free sanatorium treatment for the people who have contributed towards it.

General Mulcahy

If the amendment moved by Deputy O'Kelly had been in order and were passed, the result of it would be to throw the whole cost of medical certification on to State funds. It would also leave for the benefit of the societies the 5d. per head that, during the last few years, had actually been taken for medical certification as well as 2d. of the 6d. that insurance committees had for administration purposes and that, in actual practice, it was found was not wanted with 3d. actuarially available in respect of each insured person because of the fact that their fundamental contributions had to be brought to the nearest halfpenny. As well as throwing back that 5d. which, by an Act passed here every year, we have taken for medical certification, it would throw back into the insurance societies the 1/7 which it is now proposed shall not be spent by insurance committees, but that the equivalent of it shall be paid as a State grant to local bodies. The policy of the Executive Council is not to leave that 5d. to the societies, but—for the same reasons that actuated us in the last few years—to take it for medical certification. It is not the policy of the Executive Council, in making separate provision for local bodies to the extent of £27,000, to take the 1/7 per head or the equivalent to it, and to pay it into the insurance societies fund as extra benefit.

The Deputy questioned the whole idea of medical certification. In so far as it is possible to keep medical certification right and useful, every step that can be taken has been taken towards that end, and there is no proposal in the Bill to do away with medical certification. The point has been raised that £47,000, or even £30,000, is too much to spend on medical certification. That is a different matter, but we are not dealing with it in this particular Bill. As to the point raised by Deputy Hogan, that this is a technical Bill and ought to be dealt with by a special committee, none of the main points in the Bill is in any way technical. I do not know that the Deputy can point to any amendment which could be described as technical. Any of the amendments put forward deal with matters of very plain and superficial facts, such as whether sanatorium benefit shall be taken away from people, or whether or not something equally obvious should or should not be done.

Mr. Hogan

Does the Minister suggest that the method by which funds were made available for the administration of these benefits is plain to every Deputy, or that the method by which they were accumulated is plain?

General Mulcahy

What I suggest is plain, that if sanatorium benefit is taken away from the Act, and if we say we will pay to the local bodies the amount that insurance committees have actually been handing over to them every year for the treatment of insured persons, and that we are handing over that as a State grant to the local bodies, there is nothing technical about that. If people argue that, as well as handing over £27,000 to local bodies, another £27,000 should be left in the funds of the approved societies, there is nothing very delicately technical about that. I had no suggestion put up to me until now that this Bill should be dealt with by a special committee. I have pointed out why we were following what was done eight or nine years ago in England. I have pointed out the great increase in the provision made for tuberculosis here since 1922. I have emphasised that although sanatorium benefit was included in the National Health Insurance Act the funds provided were not sufficient to deal with all the insured people, so much so that the giving of sanatorium benefit was taken from under the Act in Great Britain in 1920 or 1921, and that the funds which have been available here for the different bodies have not been sufficient to deal with the proper treatment of the insured persons have been applying to the insurance committees for treatment. In some cases the money has been exhausted in four months, and in other cases in six months, and only those insured people who apply to the insurance committees while they are in funds can get free treatment. You have the case of an insured person in a hospital getting free treatment, and another person in the next bed having to pay 5/- or 2/6, or whatever it is, per week.

Mr. Hogan

How does this Bill improve the situation?

General Mulcahy

At any rate, I am telling what the general policy of the Bill is. We are removing the sanatorium benefits at a time when the estimated funds available for insurance committees during the current year will be £27,000, but when the expenditure by local bodies on general tuberculosis treatment in addition will be £59,000 of a State grant, plus £59,000 from their own moneys. In the year 1922-23 the amount actually given in State grants was £21,000; outside the expenditure from insurance committees there was an expenditure of double that amount, £42,000, on tuberculosis schemes carried out by local bodies. That total expenditure has gone from £42,000 to £118,000, and it is at a time when the general expenditure on tuberculosis has risen to this particular figure that we are taking away the sanatorium benefit from the Insurance Act and are regulating that the ordinary insured persons will rely on the ordinary public scheme, in the same way as many of them up to the present have had to rely. In order to secure the general position of local bodies we transfer in addition to the £59,000 that will be given as a State grant, I suppose next year as this year, £27,000 every year to these bodies to recoup them for what they will not receive in the future through the insurance committees, and while they will have to deal with insured persons. The local bodies during the current year are going to deal with an expenditure of £118,000 that insurance committees have had nothing to do with. With the exception of six counties, they are going to deal as boards of health with an additional £27,000. They are going to deal with four-fifths of that amount as well. According to the Statute under which they are set up boards of health may make provision to delegate to a sub-committee set up for the purpose any of their powers, functions and duties. Such a committee must consist of not less than three persons. It may consist entirely of the members of the board of health, members of the board of health and others, or of persons not members of the boards of health. Boards of health are appointed to do a certain class of work. Persons who are members of boards of health ought to be able to sectionalise their work, one section dealing with water schemes, another with public health, and so on. At all events the machinery is put into their hands if they want to use it. I think I have replied to Deputy Alton.

Professor Alton

Does the £27,000 include the ??

General Mulcahy

Yes.

Professor Alton

Is this going to be delivered over ear-marked so as to insure free sanatorium treatment for insured persons?

General Mulcahy

It never was so delivered over.

Professor Alton

Is there to be any free sanatorium treatment secured for insured persons?

General Mulcahy

As amended the section will read: "Such sum voted shall annually be distributed among such councils of counties and county boroughs, and such boards of health, and in such manner and subject to such conditions as the Minister for Local Government and Public Health, with the concurrence of the Minister for Finance, shall appoint."

Local bodies and boards of health in most counties have been getting from insurance societies £27,000 for the purpose of giving sanatorium treatment to insured persons. That has not covered all the insured persons. With the tuberculosis services improved as they are, we propose to take away sanatorium benefit in cases where there may be any statutory obligations of any kind on an insured person to get them, but we propose to hand over that amount to local bodies in plain recognition of the fact that we are leaving the insured people on their hands under ordinary schemes, but we are also paying them the amount they got in the past for insured persons. You definitely are passing to a period at which there will be no obligation, good, bad or indifferent, on insured persons to get sanatorium treatment, but if you put £27,000 and impose an obligation on local bodies to give sanatorium treatment you impose on them a burden which they never had, and you are securing for insured persons a right which they never had; and also if the number of insured persons increased, as it might, by 50 per cent. in another few years, you impose on local bodies fresh burdens which nobody thinks of imposing on them.

Mr. Lemass

Would the Minister explain what he means by saying that we would be giving insured persons a right which they never had? Surely they had a right to receive sanatorium benefit.

General Mulcahy

An insured person could not look for sanatorium treatment and demand it because he was insured. Many of them have been denied it year by year.

Mr. Lemass

And many of them got it.

General Mulcahy

And many of them were denied it, because funds were not available. The insurance committees had discretion as to who should get free sanatorium benefit. The representatives of trade union societies complained that insurance committees were not very democratically elected. Whatever discrimination you are going to have in future as to who will get benefit, that discrimination will be with public bodies.

Professor Thrift

Does the Minister mean that there will be an option on local bodies to give such treatment up to £27,000?

General Mulcahy

It will be at their option to give free benefit up to £118,000 plus £27,000 or £27,000 plus any other amount to which the expenditure on tuberculosis treatment is going to rise.

Professor Thrift

The amount of free benefit will not be diminished?

General Mulcahy

No.

Mr. Hogan (Clare):

The Minister said that an insured person had no right to sanatorium treatment. Will he tell us in practice whether such treatment was ever denied where there were funds and how this scheme will increase the funds available for such treatment? He hands over the contributions, which are the property of insured persons, to other purposes. Will the Minister say what was the practice and how it worked?

General Mulcahy

I will not say that cases did not arise where insurance committees did not deny sanatorium treatment to applicants when money was available. I have no information that that was the case, but I have absolute proof that the funds available for insurance committees were not sufficient to give free sanatorium treatment to every insured person who looked for it.

Mr. Hogan (Clare):

Where is it coming from now?

General Mulcahy

Persons who were insured have got free treatment very often, not by the fact that funds were available but because local bodies and the State under tuberculosis schemes provided for it.

Mr. Hogan (Clare):

The Minister has an obsession about County Homes. He has an obsession of wanting to bring insured persons into the County Homes as he has done in the case of everyone else.

General Mulcahy

I wonder whether the Deputy knows what he is talking about.

Mr. Hogan (Clare):

I am a member of several boards and I know what I am talking about.

General Mulcahy

A tuberculosis scheme in a normal county provides a tuberculosis officer, some full-time nurses, some part-time nurses, a central dispensary where he attends two or three times a week, and others where he attends perhaps once a week or a fortnight. In most counties they have special tuberculosis institutions for chronic cases, not the county home. There are arrangements to provide institutional treatment for, say, early cases of pulmonary tuberculosis such as Crooksling or Newcastle. There are also arrangements by which surgical cases, usually children, can be sent to places like Cappagh or Coole. Provision in a county home or in a wing of such home, or perhaps in a few rooms of such home, only arises in an exceptional county which is somewhat behind the times. I think that the Money Resolution should be passed.

Mr. Lemass

I was absent when the discussion commenced, but, so far as I understand it, it concerns the question whether the State should bear the cost of medical certification or whether it should be borne by insurance funds. I did not hear the Minister dealing with that question beyond saying that it was not the policy of the Executive Council to meet out of State funds the cost of medical certification. It seems to me that a good deal of what the Minister has stated has really been designed to confuse the question. There is no doubt that the State is not going to lose anything as the result of shuffling the burden under the Bill. The money which it will have to pay to local bodies in respect of sanatorium treatment will be recouped by the fact that it will have no longer to bear a share of the medical certification costs which it bore in the past. The local bodies are losing nothing, as they will continue to get contributions from the State similar to those which they got from the insurance funds. The only persons who are losing anything are the insured persons.

General Mulcahy

What are they losing?

Mr. Lemass

They are losing, at any rate, that amount of sanatorium benefit which was available before. The Minister admitted that some of them succeeded in getting sanatorium treatment as a right and free of charge under existing Acts. None of them, however, will now have that right, and they will have to take their places in line with the ordinary population and secure whatever treatment may be made available by local bodies. They are, however, to continue to pay the same contribution. That has in no way been diminished. It seems to me that if the State were to continue to meet the cost of medical certification it would be fairer than the method proposed in the Bill, because insured persons who have to pay the same contribution would be getting something in exchange for what they are losing, namely, the possibility of benefiting when their societies have surplus funds at their disposal. The State seems to me to be economising at the expense of people who cannot afford it. There is a case for keeping on the State that portion of the cost of medical certification which the State met in the past. The Minister has not answered that point beyond stating that it is not the policy of the Executive Council to do that. I would be glad if he would tell the Dáil why it is not the policy of the Executive Council to do so.

Mr. Coburn

The proposal to make the cost of medical certification a charge on insured persons through the approved societies is entirely objectionable, and is more or less contrary to the practice which has obtained hitherto. In Great Britain medical certification forms part of the medical benefit scheme. Of course in the Saorstát at the moment we have no medical benefit scheme, and until medical benefit is extended I submit that the present state of affairs should be continued, and that the 1/7 set free by the removal of sanatorium benefit from the Act should be left in the societies' funds for the provision of alternative benefits, such as dental or optical treatment. Either of these treatments might, in my opinion, be regarded as essential benefits, if the original intention of the Insurance Acts is to be preserved, namely, prevention and cure of sickness. There appears to be no justification whatever for taking permanently from the funds of the societies 5d. per annum for medical certification. That is a margin which should be left in the societies' funds to safeguard them to some extent from the danger of insolvency which at the moment threatens them. The Minister will agree that the amounts paid out in sickness benefit during the last two years has increased enormously, and the chances are that many of these societies, particularly the smaller ones, may soon become insolvent, and in consequence it may be necessary for the people who are members of those societies to have their contributions increased. I think that the present state of affairs should continue until the whole question of medical benefits has been gone into.

I always held the opinion that the introduction of this Bill should have been postponed until a full, comprehensive Bill dealing with all matters in connection with National Health Insurance was introduced. The Minister has referred to the question of sanatorium benefit, and suggests that the people who hitherto were accustomed to receive this benefit through insurance committees will receive the same benefit from the boards of health. I do not think that will be so. As Deputy Hogan has pointed out, the duties which have to be carried out by members of the public boards are very onerous and intricate. Anybody who has experience of meetings of these boards knows the long hours that are spent in going through the ordinary duties appertaining to the boards, and I do not think that this will be a wise change. Moreover, insured persons who pay for this benefit do not want to be placed in the position of having to appear before boards of health as suppliants, so to speak. They are paying for this benefit through the Insurance Act, and, as far as my experience goes, all claims have been met by the insurance committees with the moneys available. My principal objection to the change is founded on the fact that ordinary decent people who wish to preserve a sense of dignity will not like to have to appear before boards of health to obtain this benefit.

There was another point in connection with the change which is important. Am I to understand that boards of health will have power before granting this benefit to ask an applicant to pay the whole or part of the cost of sanatorium treatment? It may be that the boards of health will inquire into the means of the different applicants, and it may happen that these people will be asked to make a certain payment towards the cost of the treatment. That will be a very undesirable state of affairs. I think, for the reasons advanced by the various Deputies here, that this section dealing with the transference of the powers of committees to boards of health should be deleted from the Bill until such time as the Minister will be in a position, after consultation with the approved societies, to introduce a Bill dealing with insurance in all its aspects.

Mr. Everett

The Minister said that public boards will receive the £27,000 which was formerly given to insurance committees and that there would be a State grant of £59,000 to public bodies for dealing with tuberculosis. Is the increase attributable to the agreement arrived at with county medical officers to deal with the large number of non-insured persons? Were these public bodies not promised a fifty-fifty grant, and did the Minister not promise that he would be responsible for fifty per cent. of the cost of dealing with tubercular cases amongst non-insured persons? The amendment means, to my mind, that the Minister has discretion to change the amount allocated to each county as he pleases. For instance, Dublin, where we hear there is a large number of persons receiving sanatorium treatment, may get a larger grant from the Minister than other counties which have been administering the Act satisfactorily for a number of years. I have been a member of a sanatorium committee for the last fifteen years, and during my fifteen years' experience I have never known of one applicant being refused domiciliary sanatorium treatment or surgical treatment. It may happen in larger areas. The amendment gives to the Minister the right to take back from certain counties the amount allocated to them, and to give it to any other county he wishes. The insured persons will have no rights at all. The Minister mentioned that he is doing the same as has been done in England. The English Government, on taking away the sanatorium benefit, gave widows and orphans grants, which were not given here. The Minister seems to be giving nothing and taking all.

General Mulcahy

Medical certification normally is an integral part of the work of national insurance. It is an essential part of the cost, and but for the particular circumstances in which no agreement with the doctors was arrived at in Ireland years ago, when the National Health Insurance Act came into operation, I take it, it would be an integral part of the scheme here. At any rate, looking at national health insurance now, we have to say that where medical certification is required, the cost of the medical certification should be an integral part of the scheme. In circumstances in which, when we compare our expenditure from public funds on the treatment of tuberculosis with the expenditure in 1922-3, in circumstances in which we are spending now £76,000 more than we were spending then out of ordinary public funds——

Mr. Everett

I said that there was an agreement with the medical officers appointed by the county councils under the scheme to deal with non-insured people and that that is why the Minister is spending more.

General Mulcahy

It is not a question of non-insured people. I say in the circumstances in which we are spending £76,000 more on tuberculosis work than we were spending seven years ago, we propose to take tuberculosis treatment from under the National Health Insurance scheme and to transfer to local bodies, in addition to what we are giving them already—£27,000 per year—insured persons and transferring them over in the same way as ordinary people. I say we are doing that. We are making that change when £76,000 more than was spent seven years ago is being spent. We are doing it at a time when the total expenditure, if you include the £27,000 that I have mentioned, is £145,000. That £145,000 is being spent entirely on tuberculosis schemes, £27,000 of which, or less than one-fifth, comes from insured funds and at a time when the total number of insured persons receiving treatment is 3,492 and the total number of non-insured persons is 11,004. That is, while the moneys that are available from insurance funds are less than one-fifth of the total amount of money being spent, the number of insured people receiving treatment is more than a quarter of the total number receiving treatment, showing that a considerable number of insured persons are receiving tuberculosis treatment entirely outside the financial scheme of the insurance funds.

This is not a case of certain persons going as suppliants before the board of health or any other public body. It is a question of persons being referred either by their own private doctor to the tuberculosis officer of the county or being referred by the dispensary doctor to the tuberculosis officer of the county and being dealt with by him and having their cases subsequently reviewed by the local body responsible for the expenditure, to see if their circumstances are not such that they might be reasonably asked to pay something towards the cost of treatment. So that it is not a question of going as a suppliant before anybody like the board of health. It is being taken up by the medical machinery in the country, whether private machinery or dispensary machinery, and brought under the notice of the tuberculosis authorities and being helped in that way.

Mr. Everett

Can the Minister give us any guarantee that the insured person will receive sanatorium treatment from the board of health?

General Mulcahy

I could not have given you that guarantee three months ago because I could not guarantee that there was sufficient funds available. But I can guarantee that there were some insured persons in the country in respect of whom there were not sufficient funds available for treatment. They would be without tuberculosis treatment if we were not expending this additional money.

Mr. Everett

Persons not receiving sanatorium treatment although entitled to it as insured persons. Will the Minister state where the persons not entitled to sanatorium treatment got sanatorium treatment?

General Mulcahy

Cork County Borough for one. The insurance committee in the Cork County Borough has exhausted its funds.

Mr. P. Hogan (Clare):

Who is to say whether a person is to receive tuberculosis treatment or not?

General Mulcahy

The Board of Health.

Mr. Coburn

Will it be necessary for the insured person to appear before the local body?

General Mulcahy

No; he will have the circumstances reported to the local body. The person may be in Crooksling or in Newcastle or, if it is a child, he may be in Coole. You have had the position up to the present of a man, a member of an insurance society early in the year, being afflicted with tuberculosis and ordered for sanatorium treatment by the committee. He gets it because at the moment they may have funds. Coming along towards October or November, some one or two of his children may require treatment. But the insurance committee then has no funds for the children or for his wife. They are then dependent on the local body and they have to get treatment from it.

Mr. Everett

Under the Minister's amendment, Cork or Dublin will get the money that should go to the other counties.

General Mulcahy

Certainly not.

An Ceann Comhairle

Deputies will be able to discuss that amendment on the Committee Stage.

Money Resolution put and agreed to.