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Dáil Éireann díospóireacht -
Wednesday, 27 Feb 1935

Vol. 55 No. 1

Vote No. 44—National Health Insurance.

I move:—

Go ndeontar suim Bhreise ná raghaidh thar £3,589 chun íoctha an Mhuirir a thiocfaidh cun cheith iníoctha i rith na bliana dar críoch an 31adh Márta, 1935, chun Tuarastail agus Costaisí Oifig an Aire Rialtais Aitiúla agus Sláinte Puiblí i dtaobh Riaracháin na nAchtanna um Arachas Sláinte Náisiúnta, 1911 go 1934, agus chun Ilsíntiúisí agus Ildeontaisí, ar a n-airmhítear Deontaisí ar a n-áirmhítear Deontaisí áirithe i gCabhair mar gheall ar Chostas Sochar agus Costaisí Riaracháin fé sna hAchtanna san.

That a Supplementary sum not exceeding £3,589 be granted to defray the Charge which will come in course of payment during the year ending 31st March, 1935, for the Salaries and Expenses of the Office of the Minister for Local Government and Public Health in connection with the administration of the National Health Insurance Acts, 1911 to 1934, and the sundry Contributions and Grants, including certain Grants-in-Aid in respect of the cost of Benefits and Expenses of Administration under the said Acts.

The necessity for the presentation of this Supplementary Estimate is to meet the liabilities accruing in connection with the administration of the National Health Insurance Acts, 1911-1934, arising out of the fact that the expenditure on accidents, sickness, disablement and maternity benefits for the year has been greater than was anticipated. It is now estimated that a further sum of £6,000 will be required to meet such grants-in-aid of these benefits in addition to the sum of £59 required to meet actuarial expenses, the casual references under this heading having been more than normal, increasing the additional sum required to £6,059. It is anticipated that there will be a surplus of £20 under appropriations-in-aid, reducing the additional sum to £6,039 and it is further anticipated that there will be a saving of £2,450 on further sub-heads of the Vote, of which £2,300 is in respect of savings on salaries due to reduction in the cost-of-living bonus, vacancies in staff unfilled or filled by officers on loan from other Departments and changes in personnel. This saving will reduce the additional sum required under the Supplementary Estimate to £3,589.

I oppose this Vote on the ground of the delays that are arising in the payment of benefits under national health insurance since the change-over. Conditions were never too good in respect of the local societies, but these societies were near at hand and it was possible for the people entitled to benefit to get that benefit rapidly, but since the change-over took place, the delay has become very much greater and a large number of people are complaining bitterly. I suppose we have to take it that one of the chief causes of the delay is the fact of money running short. In cases of sickness and maternity benefit there should not be any undue delay. The employees and the employers are subscribing to this fund and there should be no delay in paying when cases arise. I have not very much to say on the Vote except to ask the Minister to see to it that in future there is not as much delay in paying as there has been in the past.

On this Estimate for money in respect of national health insurance, I want to draw the attention of the Minister to one grave defect in the existing system of national health insurance. I remember when the unification Bill was passing through, several of us made representations to him about the minimum statutory benefits that were to be provided for. I remember pointing out to him that many of the then societies were providing dental benefit and that it was proposed under the Bill to omit dental benefit from the statutory benefits. I think the time has come when the Government should seriously consider introducing amending legislation to provide dental benefit and I think that for the reason——

Of course, the Deputy is not entitled to advocate new legislation on an Estimate.

I see that. Perhaps the Minister would inform us as to whether he has power to increase the statutory benefits by order under the Bill? It would require legislation to increase the benefits?

I am afraid so.

That precludes me from referring to the matter further.

I think the Minister is familiar with the fact that social services generally are in a very uncoordinated state to-day and that various Departments look after various aspects of social legislation. Each new piece of social legislation seems to be a self-contained piece of legislation and apparently no effort is made to regulate these items of legislation and to bring them into a co-ordinated whole. The Minister, I think, when we were discussing the question of the National Health Insurance Act, indicated his own belief in some kind of a co-ordinated scheme——

Is the Deputy again advocating legislation?

No; I am inquiring whether the Minister still holds the views he then expressed.

And, incidentally, advocating it.

The Minister advocated it.

That is no reason why I should allow the Deputy to advocate legislation.

I am not going to advocate legislation. What I want to know is whether the Minister can tell the House if there is any Departmental Committee examining the question of national health insurance in its relation to other aspects of our social service and if there are any proposals in contemplation for the regulation of these various social services and co-ordination of national health insurance legislation with the various other items of social legislation to which national health insurance is in some way related.

Can I raise the question of dental benefit in the same form by asking the Minister if he is of the same opinion still, taking the long view, that dental benefit is a useful benefit to provide under a national health insurance scheme, and whether he is in a position to inform the House if there is a committee at present considering the desirability of adopting this useful reform? Might I further ask whether he has addressed his mind as yet to the question of the value, taking a long term view, of a benefit of that character and whether, recognising that, at the moment, it might throw a considerable burden on the funds of the Unified Society, he has considered that the provision of dental benefit in Ireland would result in a very material relief to the funds of the Unified Society in, say, 20 or 30 years' time. Has he considered that if he fails to provide that benefit now, he is perpetuating, not only a recurring sickness benefit but perpetuating what almost invariably turns into disablement benefit, because I think his Parliamentary Secretary will inform him that one of the commonest causes of that type of rheumatism which incapacitates hundreds of subscribers to the national health insurance fund has its origin in dental defects in the earlier years of the insured person's life? The object of my proposal is to provide now a benefit which would, in the long run, pay for itself not only from the point of view of the finances of the society but also from the general public health point of view of the whole community.

At the present moment I am not concerned with future benefits, but I am concerned with the benefits which the people are entitled to and are not receiving. There is no question but that, throughout the country, we have complaints in regard to undue delay in dealing with the claims of the poor people. We have claims awaiting six or seven weeks, and, in the meantime, those people have to receive home assistance. We find the most frivolous excuses from Dublin, such as a wrong number being sent up by an agent, instead of the officials dealing with the proper cases that arise.

I have three cases in mind. One is the case of a man who had been in receipt of disablement benefit for two years. The superintendent under the unification scheme was the superintendent under the original insurance scheme. The moment it came under the Local Government Department, the same superintendent reported that this man's illness was a result of an accident. This man himself proved by medical evidence, by the evidence of surgeons in Dublin, that his illness was in no way the result of an accident. The Department was not concerned. They cut off the man's benefit and left him at the mercy of the local home assistance people. That poor man had no money to fight his case. If the insurance people had any doubt that it was the result of an accident, their proper procedure would have been to continue the payment of the benefit and take proceedings in the court against the man's employers. Instead of that they left the poor man in bed for two years without giving him any assistance.

There was another case where the Unified Society held that the poor man was 70 years of age. Evidence was submitted to them that he was not 70 years. They refused to accept that evidence. After the lapse of four or five weeks that evidence was supplemented by his birth certificate, which proved that the man was right. But, up to Christmas I found that the man had not received his benefit and was still on home help. We got word that there was some mistake, not in any certificate that had been issued, but we got proof that the certificate had been sent to the local agent 20 miles out of his area. That had been sent from the Health Office in Dublin; it went to the wrong agent. Then, in that case, a second certificate had to be procured. We have other cases where on the most frivolous pretexts men were turned down and placed as a burden on home help and on the local authorities.

Then again, we have in this society full-time agents who are paid the miserable wage of 30/- to 40/- a week. I ask the Minister to contrast the payments to these poor agents who have to travel long distances around the country with the treatment that is given to a member of the Committee of Management who only attends once a week. There is no question in that case of cutting down the remuneration. You have blue lights, green lights and red lights in the office. I want the Minister to see that there will not be so much of this red-tape in future, and that it will not be a question of red light, green light or blue light, but that the man will get benefit when he has presented a proper claim. I have submitted several cases where men have been entitled to benefit, but have not got it.

I can well understand there being some excuse in the case of a small society. We understood that once the business was centralised in Dublin that particular care was to be taken that the people in the rural areas would be attended to. Instead of that, these people have been made wait, and where they do receive benefit sometimes they do not get it for a month. I have definite information that one man who had been in receipt of benefit of 7/6 a week since the Unified Society was set up, has been cut down now to 1/6. The sooner the Committee of Management is changed the better. It should not be a case of one man going down once a week, and for that one day's attendance he gets better pay and better treatment than the poor agent who has to go through rain and storm around the country collecting money.

If the thing is to be made a success there must be a satisfied staff. A man cannot take a real interest in his work when he is only getting £2 a week, while he sees thousands spent in Dublin in connection with the management. We were assured that there were to be increased benefits once the Unified Society was set up and that there were to be no further complaints from the insured people. I can only say that in my ten or 12 years' experience on public boards I never heard so many complaints as we have at present about the delays in the payment of benefit. I am not blaming the agents. They send their reports here to Dublin, but there does not seem to be any co-ordination in the system. With the number of red lights and green lights they have one would imagine that it was into an Indian prince's chambers one was going, rather than into an insurance office. Instead of spending money on tomfoolery the money should be spent in giving benefit to the people.

In answer to-day to a question by Deputy Byrne about delays in the payment of benefit, I furnished a statement that I believe to be correct. From inquiries made I find that 98 per cent. of the benefit was paid out 24 hours after the certificates were received. Never in the history of any of the former non-unified societies was such a high average reached. Deputy Everett talked about complaints. He did not send any complaints to me.

I sent them to the Department.

But not to me. Send on the complaints to me and I will go through them. I am nearly certain if these complaints are sent on to me, that it will be found that 90 per cent. of them will turn out to be the fault of the people themselves or of the agents. That is my experience after examining the complaints that have been sent in.

I have only mentioned three.

Very good. The Deputy said he had many other cases. I would be very glad to examine them and will do the same for Deputy MacEoin or any other Deputy who sends me a complaint. I do not like to have these complaints. I do not like these people to be without their money. It is not a creditable thing, but from the examination of complaints that I have already undertaken I am satisfied that the delays are due in 90 per cent. of the cases to the people themselves sending in the wrong number, the wrong address, the wrong age, and so on. I would be glad if every Deputy in the House would take that invitation and send any complaints they have to me. I will have all these complaints examined and Deputies will be told the result of that examination.

With regard to the other points raised by Deputies Norton and Dillon, I want to say I have not changed my views on the question of social services. I do hope to see many useful developments arise as a result of the unification of the societies. The unification, to my mind, is only the first step in the endeavour to put this so-called health insurance on a real health insurance basis. I do not regard this as a proper measure of insurance for the promotion of health. There is a variety of other important steps that I hope, in good time, will be taken to co-ordinate the social services. To begin with the first step and one that seems to me to be the most necessary—unification—has only just been taken. Unification of the various organisations connected with the national health societies has never been accomplished and it will take some time with the assistance of everybody to bring that about. It will take some time to have various other steps completed before the other things we have in mind can without very great initial cost be added to national health insurance.

Some of the services that were previously given by some of the societies will then be brought into existence. I believe these things must come. National health insurance must be made a real insurance for the promotion and preservation of health and social services generally. Instead of being scattered as they are, they must be co-ordinated and reorganised. That is a heavy undertaking and it will take time. We have only got over the initial step this year. I am not going to say anything about the Committees, but I will say this much, that an examination is being made of the situation, particularly in so far as it affects national health insurance. The amendments and improvements that I have in mind are a cumbrous business. To get this Committee into the form that is necessary for the due consideration of these matters is a thing that is not being lost sight of, and at some date in the future, as soon as this work connected with the unification is accomplished, I hope to be able to make some announcement with regard to the further steps that will be taken in the direction of improving, co-ordinating and developing national health insurance and similar social services.

Vote agreed to.
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