I move:—
That a supplementary sum not exceeding £324,225 be granted to defray the Charge which will come in course of payment during the year ending 31st March, 1949, for the Salaries and Expenses of the Office of the Minister of Health, and certain Services administered by that Office, including Grants to Local Authorities, miscellaneous Grants and a Grant-in-Aid, and certain charges connected with Hospitals.
The original net Estimate for the Department of Health was £1,355,590. This was later increased to £1,361,590, as a Supplementary Estimate of £6,000 to provide funds for an expanded scheme of health publicity was subsequently introduced. It is now anticipated that, after making allowance for savings amounting to £11,000 on certains items of the Vote, the charges which will come in course of payment within the year will, for reasons which I shall presently explain in more detail, amount to £1,685,815. It is accordingly necessary to seek a further supplementary grant of £324,225. The sub-heads under which this Vote will be accounted for are:
Sub-head E—Expenses in connection with international and other congresses, additional sum required £3,625.
Sub-head H—Grants to health authorities, additional sum required £231,000.
Sub-head M (1)—Child welfare, schools for mothers, etc., the additional sum required is £4,925.
Sub-head M (2)—Grants for the supply of milk to necessitous children, additional sum required £1,800.
Sub-head M (3)—Medical treatment, etc., of school children, additional sum required £8,675.
Sub-head M (4)—Prevention and treatment of tuberculosis, additional sum required £80,500.
Sub-head M (5)—Treatment of venereal disease, additional sum required £4,700. The provisions under sub-heads M (1) to M (5) represent balances of grants due in respect of years previous to 1948-49. I shall now explain the details of the sums required under these sub-heads.
The main increase arises under sub-head H—Grants to health authorities. The original Estimate for this sub-head was £1,450,000 and the additional sum now required is £231,000, making a revised total Estimate of £1,681,000. The grants under this sub-head are payable in pursuance of Section 4 of Health Services (Financial Provisions) Act, 1947, and are intended to recoup the excess of approved health expenditure in the current year by each health authority over standard expenditure, which is the net expenditure on health services of each health authority in respect of the year 1947-48. Pending the completion of the audit of local authority accounts, it was necessary to base the grants on estimated figures of standard expenditure as well as on estimates of the health authorities' expenses in the current financial year and it was, therefore, difficult at the time the Estimates were prepared at the end of 1947 to make accurate forecasts.
The increase in health authorities' expenditure represented by the above figures arises under several headings and is a consequence of the intensification of health measures advocated by my Department and effected by local authorities during the present financial year. In addition there was increased expenditure on stores and equipment, much of which was not available during the emergency.
One of the aims announced by the present Government when it took up office was the taking of immediate steps to provide additional facilities for the treatment of sufferers from tuberculosis. In pursuance of this aim my Department has concentrated particularly on the provision of extra beds and the progress made in this connection can be judged from the fact that over 800 extra beds have already been provided and this figure will, within a period of six months, be increased to approximately 1,300 beds. A new service designed to provide expert surgical treatment free of charge for tuberculosis patients of health authorities has been initiated on a regional basis.
A scheme of monetary allowances to sufferers from certain infectious diseases, mainly tuberculosis, was brought into operation generally by health authorities on the 1st April last in accordance with the provisions of the Infectious Diseases (Maintenance) Regulations, 1948. These allowances have proved of substantial benefit to eligible persons by relieving them of anxiety for their own maintenance and that of their dependants while they are receiving treatment. To ensure liberal administration of these regulations and to enable them to be of the maximum benefit to tuberculosis sufferers it was necessary during the year to amend the scheme of allowances.
Special courses at home and abroad were provided during the year for medical officers of health authorities who are engaged on tuberculosis work and a scheme of training of probationer nurses for a new grade of sanatorium nurse was initiated with the co-operation of the General Nursing Council during the present financial year.
New Infectious Diseases Regulations came into operation on the 1st April, 1948, and allowed amongst other things for the provision of free treatment of cases of infectious diseases. During the year measures for the control and prevention of various infectious diseases were intensified. Local authorities and voluntary bodies have been urged to proceed with the greatest possible dispatch with approved hospital projects and public assistance authorities have been urged to take steps where necessary to bring dispensaries up to a reasonable standard.
The intensification of these and other health measures has reflected itself in increased expenditure by local authorities and under the statutory arrangements made by the Health Services (Financial Provisions) Act, 1947, extra expenditure is in approved cases recouped from the Health Services Grant. Apart from the measures mentioned, substantial increases of remuneration to local health staffs and improvement in working conditions have been authorised during the year and these also have the effect of increasing local expenditure on these services.
The supplementary sums required under the sub-heads M (1) to M (5) are intended to meet the balances of grants for 1947-48 and previous years falling due as the audits of local accounts are completed. The balances in respect of previous years are ineligible for inclusion in the health expenditure of health authorities for the purposes of the Consolidated Health Services Grant for 1948-49. For that year and in future expenditure on these services will fall to be recouped from the Health Services Grant and will be provided for under the sub-head for that grant, instead of under separate sub-heads as heretofore.
Of the £4,925 additional provision necessary under sub-head M (1)—Child Welfare, Schools for Mothers, etc., to pay grants not exceeding one-half of approved net expenditure of local authorities under approved regulations, a sum of £2,900 is for recoupment in respect of 1947-48 expenditure recorded by the local authorities after 31st March, 1948. The balance of the new provision is necessitated by increased salary charges (in some cases retrospective to 1st November, 1946), increased cost of hospital treatment, etc.
Under sub-head M (2)—grants for the supply of milk to necessitous children, the additional sum of £1,800 is also required to meet balances of grants in respect of previous years payable to local authorities. The annual grant paid to each local authority under this sub-head was 100 per cent. of the approved expenditure up to the limit of the allocation in each case, based on expenditure on the scheme in the preceding year.
The £8,675 additional provision under sub-head M (3)—medical treatment. etc., of school children, is required to pay balances of grants to local authorities in respect of previous years not exceeding half the sums spent on approved schemes. Of this Estimate, £6,000 is in respect of expenditure for the year 1947-48 and the remaining £2,675 is necessitated by increased charges to be met by local authorities as a result of increased remuneration paid to dentists, ophthalmologists, etc., and increased charges for treatment at voluntary hospitals. Under sub-head M (4), an additional provision of £80,500 is required to pay balances of grants to local authorities in respect of previous years, calculated on the basis of 50 per cent. of the net cost incurred by local authorities under approved schemes for the prevention and treatment of tuberculosis. £47,000 of this sum is in respect of expenditure for 1947-48 brought into account after the close of the financial year. The remaining £33,000 is necessitated by higher costs of operating local authority sanatoria and of providing treatment and nourishment, clothing, beds and bedding for tuberculosis patients.
An additional sum of £4,700 over the original Estimate of £4,800 is required under sub-head M (5)—treatment of venereal diseases—to pay balances in respect of previous years of grants to local authorities, calculated on the basis of 75 per cent. of approved expenditure. Apart from expenditure in respect of 1947-48 recorded after 31st March, 1948, the extra provision under this sub-head is necessitated by increased expenditure by health authorities following recognition on 26th June, 1947, of the Hospital of St. Margaret of Cortona as an institution for the treatment of venereal diseases. Prior to such recognition this hospital was financed by an annual grant from the Vote for my Department.
The main reason for the excess on sub-head E arises from the payment of our 1948 contribution to the World Health Organisation. At the time the original Estimate for sub-head E was prepared, the scale of contributions by member states of the World Health Organisation had not been determined and only very limited provision was made in the sub-head for such a contribution. The First World Health Assembly, which met in June, 1948, adopted a unit scale of contributions (based on UNO criteria) under which Ireland was expected to contribute 0.34 per cent. of the total budget of the organisation for the year 1948. This percentage may be regarded as favourable to us when viewed in the light of other contributions payable by this country to similar international bodies. The contribution amounted to £4,131 odd. This is offset by a sum of £254 included in the original estimate in respect of our subscription to the International Office of Public Health. The functions of that office are being performed by the World Health Organisation and further subscriptions to the former body will not arise.
It is expected that this country will benefit considerably from the exchange of information available through membership of this body, which as already mentioned performs the functions of the International Office of Public Health, Paris, and also of the Health Organisation of the former League of Nations. Regular and helpful reports on the incidence of pestilential diseases throughout the world and much valuable data, on request and otherwise, in regard to other health matters have been received from the organisation which is only at the beginning of its work. It is hoped that in time facilities for the grant of fellowships to Irish medical and ancillary personnel will be obtained. An additional sum of £75 is also required to meet expenses of £45 in connection with the attendance of the Inspector of Mental Hospitals at a Congress of Mental Health held in London in August, 1948; and expenses of £40 in connection with the attendance of a representative of this country at a meeting of the Executive Board of the World Federation for Mental Health held in Amsterdam in January, 1949. The holding of this congress and meeting was not foreseen when the original Estimate was drawn up.