Before we get down to discussing the Committee Stage, I would like to make a few remarks. The Minister will appreciate that this is a very technical Bill. While I will not endeavour to compare it with the previous Bill—I would not claim to be infallible in that respect—would the Minister be good enough to indicate, either in the sections as discussed or generally, whether a particular section retained in this Bill is the same as in the previous Bill, or have I got to go to the trouble of asking the Minister on every occasion that this occurs and get an explanation every time as to where a section agrees with or varies from a section in the previous Bill? I am only concerned with accelerating the discussion and not with putting questions to the Minister just to get an answer.
Committee on Finance. - Social Welfare (Insurance) Bill, 1951—Committee.
Generally speaking I will do as you ask, but I may not be able to do so on every section.
SECTION 1.
As far as I can see, this is the same as Section 1 of the previous Bill, except that sub-sections (8) and (9)——
Section 1 is just the title.
Sorry, I thought it was the interpretation.
I may have to move an amendment to this section on the Report Stage, because the Bill has changed very substantially in regard to certain amendments. I think we will have to take out the word "insurance" on the Report Stage. The Bill will then be known as the Social Welfare Bill, 1951.
Will that involve a change in the Long Title?
No.
Question agreed to.
SECTION 2.
Am I right in thinking that this definition section extends over pages 6 and 7 and that the greater portion of page 8 is the same as previous definition section with the exception sub-sections (8) and (9)? On the sub-section, take the definition "orphan." There are two definitions of the word "orphan", as I understand the position, one for the purpose of the Children's Allowances Act and another for the purpose of the Widows' and Orphans' Pensions Acts. What are we banking on with regard to this and, similarly, in respect of the definition "qualified child"? What is the definition? Does it tie up with the Children's Allowances Act or with the Widows' and Orphans' Pensions Acts?
I cannot say exactly, but I think it follows along the lines of the Children's Allowances Act.
What is the position in respect of "qualified child"?
That is the same.
Does it tie up with the Children's Allowances Act or with the Widows' and Orphans' Pensions Acts?
They will be ruled by the new definition, but it is the definition in the Children's Allowances Act.
I want to ask the Minister to amend the definition to cover "widow" for the purpose of the Widows' and Orphans' Pensions Acts. A case has been put to me, and I have examined it and found it to be correct. I am referring to the case of a woman who is married and whose husband disappeared roughly 25 or 27 years ago. That lady is not a widow within any definition that I can find.
She is a grass widow.
As Deputy O'Leary says, she is known as a grass widow. However, that is not a technical definition of a widow within the meaning of the Acts. I do not know whether or not there would be many cases like the one I have outlined. The trouble involved in getting a presumption of death in such cases is pretty considerable. I was wondering if the Minister would consider between this and the Report Stage a case in which a husband has not been or cannot be traced for a period in excess of 25 years so that his wife can be declared to be a widow for the purposes of the Acts on a statutory declaration by her. I am aware that there are a lot of difficulties in such cases, and I would like the Minister to think the matter over.
As the Deputy is no doubt aware we have been following the ordinary law in this matter. The only remedy a woman has got is to get a court order presuming her husband's death. We could not deal with the matter in any other way. However, I will have what the Deputy suggests considered, but I feel it will not be possible to do anything.
In actual fact, the person who has brought her case to my notice is employed by the Department of Justice. She will shortly be giving up that employment and would like to be brought within the definition of "widow."
I would like to support what Deputy Cowan says in this regard. I do not think the Department acts strictly in accordance with the law. It seems to me that the Department takes evidence as to the probability of death having occurred and that it does not insist in every case on a court order being made to presume death. In my view, the Department has been disposed to take the view that, if there is a probability of death having occurred, having regard to the length of time that has elapsed since the wife last heard from the husband and having regard to his age, a pension should be granted in these circumstances. I dealt with the case of a man who was working in London and then went to Spain during the Spanish Civil War. Nothing was heard about him afterwards. Nobody knows where he is, whether he is still there or whether he was killed there. Having regard to the fact that he went to Spain, which was a troublesome country at the time he went there, and bearing in mind the man's age even if he did survive in Spain, the Department granted a pension to the wife. It was a liberal approach to the problem. It is a pity to put a woman to the expense of getting a court order. In any case, she is reluctant to have the case dragged into public. If there were any improvement in the situation, everybody would welcome it.
As the matter stands it is not necessary to have a court order but the procedure is much the same. We must presume the husband dead before we can do anything. I cannot, therefore, deal with a grass widow.
No, but the presumption of death by the Department is inexpensive compared with the court procedure. If the Department approaches the thing in a liberal manner there is a lot to be said from the point of view of not putting the widow to the expense of going to court.
That is true. There is one other matter. We will have to consider an amendment dealing with a definition of domestic servants. I am told it may be necessary. If so, it will be brought in on the Report Stage.
I move amendment No. 1:—
In sub-section (4), page 9, lines 25 and 26, to delete "or Section 72" and substitute ", Section 72 or Section 82".
This is a correction which should have been made in Section 72 as well as in Section 82. Section 82 is similar in import to Section 64, that is, an Order which requires the sanction of the Minister for Finance and that should have been specified there as well as in Section 72.
Would the Minister say what is the effect of sub-section (4)? I think exception was taken to giving the Department of Finance these powers when the previous Bill was discussed. Has someone been converted in the meantime?
I do not know. It is not an unusual thing to put in in certain sections of a Bill "subject to the sanction of the Minister for Finance". Instead of putting that in in five or six different places they are put altogether.
I am not complaining. I was wondering who was the convert.
I do not know.
On the question of these regulations, are they regulations which will be laid on the Table of the House?
As a matter of fact, I think the Deputy may have noticed that that was omitted from this Bill, but I intend to bring in an amendment on the Report Stage, to the effect that all regulations will be laid on the Table of the House.
I move amendment No. 2.
In sub-section (1), line 8, to delete "and 5" and substitute ", 5, 6 and 7."
Paragraph 6 of this section refers to share fishermen and paragraph (7) to outworkers, which two classes are being brought into Part I of the First Schedule by later amendment. Certain classes of outworkers only are insurable under the National Health Insurance and Widows' and Orphans' Pension Acts and only those share fishermen who are employed under contract of service. Outworkers are not insurable under the Unemployment Insurance Acts as they are not employed under contract of service, and share fishermen are specifically excepted from insurance under those Acts. As the Social Welfare (Insurance) Bill, 1951, stands at present the only persons of those two classes who would become insured on the appointed day are those share fishermen who are employed under contract of service. It would be possible to bring both classes into the regulations but it is considered unwise to leave the Minister's powers in relation to those two classes in the rigid state which this procedure would entail. It has, therefore, been decided that share fishermen and outworkers be added to Part I of the First Schedule and that they be also added to the classes named in Section 12 where powers are taken to modify the provisions of the Bill in the case of such classes. It will come up again under the Schedule and it will be dealt with as well under this amendment.
I think the Minister might tell us what he intends to do in relation to (a), (b), (c) and (d). The regulations may modify the provisions of this Act in their application in the case of persons employed in any of the employments specified in Part I of the Schedule or to persons employed as teachers in national schools or as teachers in secondary schools or to persons employed as members of the Army Nursing Service. Would the Minister indicate what he proposes to do in respect of the application of this Bill to those classes? The position, of course, has radically changed under this Bill as compared with the previous Bill. A case could be made for bringing in certain classes here on the understanding that in return for their contributions they are going to get certain benefits or stand in the position in which there was every probability that certain benefits would inure to them and they would get those benefits under the Bill.
If you take the case of a Guard, civil servant or a national teacher, if this Bill is applied to him as it stands now it is going to cover him for sickness benefit, unemployment benefit and widows' and orphans' pensions purposes. So far as sickness is concerned, the terms of his employment are with his employer and entitle him to sick pay while he is ill so that so far as employment is concerned it is not a real risk with him because he has got a permanent pensionable post. So far as coverage for widowhood is concerned, if he has a salary at present under £500 he can already cover himself for that as a voluntary contributor under the Widows' and Orphans' Pensions Act.
There are no other benefits of any value that he can qualify for. Yet the provisions of this Bill apply to him unless the Minister sees fit to modify the application of the Bill to these particular classes. If you had provision by which you could get retirement pension, death benefit, increased maternity benefit or maternity allowance—these are risks which materialise in respect of most classes of citizens—you could always say: "We are taking contributions from you and not merely covering you for long-odds hazards but for some certainties as well." This Bill propose to collect contributions from him and yet only covers him against long-odds risks.
I agree that there is provision in the section to enable the Minister to modify the application of the Bill to civil servants. I think the present Government, when in opposition, were not too enthusiastic about the application of wider provisions than are in this Bill to people who are in what might be described as stable employment of that kind. I should like to know in what way the mind of the Minister is travelling as regards the application of this Bill to persons such as ordinary soldiers, officers, civil servants, Guards and teachers, primary and secondary.
Naturally, this is a section in respect of which the agreement of the Minister for Finance is necessary. I have not yet had an opportunity of consulting the Minister for Finance about this particular class. I do not know if my Department has had even preliminary discussions with the Department of Finance. Subject to that, however, my opinion is that soldiers are in a different class because members of the Defence Forces will, after a period of years, come out into the world and seek employment. For that reason I think they should be covered against unemployment, sickness, widowhood and so forth. On the other hand consider the position of civil servants, teachers, Guards and so forth. They have their own superannuation scheme. Even if we had superannuation in this measure I do not think that it would be necessary for them. They have their own sickness scheme. There is no such thing as unemployment so far as they are concerned. The only thing that would be of service to them is the widow's pension. Whether it is worth while to apply the scheme to them for the sake of that one benefit, I do not know. There was a power for people to opt into that particular part of national health in the old days but I do not know if it will be possible in the future. Those who are at the moment voluntary contributors in the Civil Service and so forth for a widow's pension will be enabled to remain as voluntary contributors if they so wish. I would be inclined to say that I do not think these people should be brought in. Civil servants, teachers, Guards, local government officials, and so forth, have their own pension scheme.
At present, under the Widows' and Orphans' Pensions Act, a person who has not more than £500 per annum is covered by the scope of the Act. That Act is running for the moment. I take it that if these people are to be exempt from the scope of this Bill—and I think they ought to be exempt, having regard to the different character of the Bill—they will be allowed to continue under the Widows' and Orphans' Pensions Act since they are statutorily liable to contribute under that Act to-day.
Certainly they would be permitted to continue as voluntary contributors.
That is clear, to some extent. Does that mean that a person who is now compulsorily insured under the Widows' and Orphans' Act will be allowed to continue under the Widows' and Orphans' Pensions Act? At present, persons are covered under the Widows' and Orphans' Pensions Act where their remuneration does not exceed £500 per year. If they are exempt under this Bill—as I understand from the Minister they will be— then I take it they will continue under the Widows' and Orphans' Pensions Act. Is that so?
Yes.
Suppose they are not under that Act at the moment because their salary is over £500. Under this Bill they will be covered if they are up to £600 per annum if the Bill applies to them. Where they are exempt under this Bill, can those between £500 and £600 come under the Widows' and Orphans' Pensions Act because, as a class, they would, presumably, be excluded from this Bill?
There would be no change in either case.
You would say to the civil servant, for example: "We do not propose to apply this Bill to you but you can continue for the purpose of the Widows' and Orphans' Pensions Act, as at present. However, if you have more than £500, you would be covered by this Bill if we let you in. But, as we are not letting you in, you must go out and you cannot come in for widows' and orphans' pension purposes on a voluntary basis." Is that the position?
It is compulsory so far as the insured person is concerned for widows' pension purposes.
I know that. Having now decided to exclude these classes of persons from this Act, I want to make quite sure that nothing is done which imperils their right to continue as contributors under the Widows' and Orphans' Pensions Act——
They will be all right.
——and that that will apply not only to those contributors but to all other persons who, if this Bill never saw the light of day, would continue to be insurable under the Widows' and Orphans' Pensions Acts.
That is right. The civil servant, and so forth, will have to insure on the widows' pension side.
Not merely those who are now insured but those who enter the service subsequently?
That is right.
Can we take it that the intention is to exclude these classes?
From everything else?
Yes.
That is my opinion but I have not consulted the Minister for Finance. I think he is hardly likely to say that they must come in.
You will be a most welcome visitor if you suggest excluding them. I remember the temperature which was created when I tried to bring them in.
Is Section 13 the same as the previous section, on the same subject?
Yes, it is the same.
Treatment benefit is kept under this section by sub-section (2)?
Yes.
I understood—it was certainly my view but the responsibility now devolves upon the Minister—that so far as treatment benefit is concerned, the desire was to make it available free where it was obvious that the person definitely needed treatment such as hospital treatment. Apparently there has been a change from that practice. A few years ago, the charge paid by the then National Health Insurance Society to hospitals who treated members under the National Health Insurance Acts was £2 12s. 6d. per week. The Department of Health, anxious to save money on making good the deficits in the hospitals, encouraged the hospitals to charge four guineas a week to local authorities and to the National Health Insurance Society for such patients. The problem then arose what was going to happen the national health insurance contributor. The society was paying £2 12s. 6d. for him, the hospital wanted four guineas from him, and his benefit was only 22/6 a week. In that situation I decided at the time that we would have to find the difference between the £2 12s. 6d. and the four guineas a week, so as to enable the person to continue to go to hospital and have treatment free. The responsibility for paying benefits rested on the National Health Insurance Society or the Department as it subsequently became.
Recently, I understand, the hospitals have indicated that they propose to charge five guineas a week in respect of the treatment of patients from local authorities and patients under the National Health Insurance Acts. The Department of Social Welfare has decided that the Department will pay four guineas a week for these people while in hospital and as the hospitals want five guineas, the persons concerned will be expected to pay the other guinea out of the 22/6 per week benefit they are at present receiving. I understood that to be the effect of the new scheme which is operating or which will operate at some date in the immediate future. If the Minister says that is not so perhaps he would take this opportunity to clarify the position.
It is true that the hospitals are now charging five guineas a week. They introduced that charge some time in January and up to 31st March the Department of Social Welfare paid the five guineas a week. We did not think we could exceed a total of £500,000 this year in payment for treatment benefit and the only way we can keep within £500,000 is by subscribing only four guineas a week for this financial year. In the case of a patient who would ordinarily be sent in by a local authority to the hospital, the local authority will pay the other guinea. That is, the local authority is saved four guineas a week there. The National Health Insurance Society pays four and the local authority pays only one. Where the person is not one who would ordinarily be sent in by the local authority, that person will have to pay the extra guinea himself, if the hospital insists on it. There is the objection that the person could get treatment for the four guineas formerly.
The Deputy knows that even before this at all, the national health insurance beneficiary had the option of going to a hospital, even a private hospital that was charging more than four guineas and paying the difference himself. The National Health Insurance Society will not deduct from the benefit the amount due by the patient to pay it over to the hospital. People will draw benefit as usual. Some confusion arose over this because some of the benefits were held back. The Deputy will know why that was done. In the case of persons who have no dependents and go into hospital, usually nothing is payable until they come out again. That practice was continued and it appeared to be feared that the reason that the money was held back was to pay the extra guinea to the hospital. That is not true.
Do I take the position to be that if they are sent in from the local authority the local authority will pay a guinea and the Minister will pay four guineas?
That is right.
If they are not sent in by local authorities, the hospital may make a charge of five guineas from the book-keeping point of view. The Minister will then pay four guineas but there is no obligation on the individual to pay the other guinea?
The hospital can insist on the individual paying the other guinea.
I want to make sure of that. The hospital may refuse to allow such a person in unless he is prepared to pay an extra guinea?
Yes.
I do not think that is a desirable position.
If that is a person who is not of a class, according to means, who would be sent in by a local authority, after all I do not see that he has any terrible grievance because if such persons were not insured under the National Insurance Act they would have to pay five guineas a week.
I think that is an oversimplification of the situation, and what the Minister has stated confirms my fears in connection with this situation. When the hospitals were paid two and a half guineas, they were encouraged by the Department of Health to push up the fee to four guineas and even efforts were made by the Department of Social Welfare to put a stay on the operation of the new charges. We were anxious to have a stay put on it because moneys were being taken for hospital treatment. We were working within a limited figure but that was not an insurmountable difficulty. The hospital charges then went up to four guineas and I decided that the Department should pay the whole four guineas. What has happened now? The charge has gone up to five guineas with this difference, that whereas previously when it went up to four guineas, we put more money into the kitty to relieve the additional charge, the present position is that the hospitals are charging five guineas and the insured person is liable to pay the hospital one guinea per week. Is that not clear?
Yes.
I think that is unfair. Let Deputy Captain Cowan look at that. If the insured person has means the hospitals will put their hands in his pockets and take it from him. I met this charge by putting one and a half guineas extra into the kitty for the insured person. Why should not the Minister meet the extra guinea now? I would not put it on the insured contributor. The State had to put the money into the kitty to pay for the insured contributor and the State paid the four guineas. If I were faced with a similar situation of having hospitals demanding five guineas, this State would have to put up the money because the insured person cannot pay. He should not be expected to pay it out of national health benefit of 22/6 a week for himself or 22/6 a week if he has got a wife and any number of children. That is the maximum rate of benefit he is getting to-day under the National Health Insurance Society. Even if the new Bill becomes operative the same man will get only 24/- a week. He will have to pay one guinea out of that to the hospital. I think that is grossly unfair. In 1949, the National Health Insurance Society had £4,500,000 to its credit. That was something lower than the previous year, but if you look back over the figures from 1937 you will see that the society, which had £718,000 to its credit in 1937, had £4,500,000 to its credit in 1949.
Although its assets have been going up at that very rapid rate, it is acting with the insured person as if he was just Lazarus because the insured person is going to be asked now for the first time since the National Health Insurance Act was passed in 1911 to pay a guinea per week to the hospital out of 22/6 a week while the State has £4,500,000 in the kitty from which it could take a guinea in respect of every week an insured person spent in hospital without the slightest difficulty. I took with the same ease one and a half guineas—not one guinea—from the State funds in order to meet increased hospital charges when that problem arose earlier. I think the Minister is treating this whole matter too lightly by saying that the local authority may pay it. I do not know whether the Minister has any experience of local authorities and the way they deal with these matters.
Take the case of a carpenter in Dublin or Wexford. When he falls sick he goes to hospital. The local authority would not send him to hospital under any circumstances once he is a national health insurance contributor. He goes to hospital because he is a contributor. The first thing the almoner asks him is whether he is a national health insurance contributor. If so, that fact is recorded and the Department is charged for the cost of his maintenance there. To imagine that a local authority would send a carpenter, a docker, a painter or a plasterer to a hospital at its expense is just drawing on one's imagination. That does not happen. It has not happened and it will not happen. That carpenter may be earning £7 10s. 0d. or £8 0s. 0d. to-day. If he has to go to hospital he will be liable to pay one guinea to the hospital out of 22/6 which sum he will get not while he is in hospital but when he comes out. He has got to keep himself in the meantime. The Minister should undertake to look into this matter again.
The State has £4,500,000 in the kitty. I believe it is much more than £4,500,000 now. There must be something in the vicinity of £5,500,000 to £6,000,000 in the kitty, some of it even invested in British securities. We are asking the Irish insured contributors whose money this is to leave the money alone and to recognise that he has an obligation of paying a guinea a week to the hospital. Did anybody ever hear a worse situation than that in which the insured persons, having built up a kitty of from £4,500,000 to £6,000,000 which should be available for their benefit and aid, when admitted to hospital have to pay one guinea per week while the Department will not touch their money or allow them to touch the money? I would appeal to the Minister to review the whole matter and put it right because it is grossly unfair to the insured person.
I would appeal to the Minister also to reconsider the position. From what I know of local authorities and local authority hospitals it would be much harder to get any reduction from the local authority hospitals than from the voluntary hospitals. If a patient goes to a voluntary hospital he will have some opportunity of getting a reduction in his bill. The picture is not altogether as Deputy Norton painted it. As soon as this Bill is passed the insured contributor who has a wife and a couple of children will get £2 10s. per week instead of £1 2s. 6d. At the same time I think there should be no charge of one guinea a week on those people if it can be avoided at all. The voluntary hospitals are the only ones inclined to make any concession. When a person goes into a local authority hospital in Cork he is first questioned by the home assistance officer before any reduction is made.
I gathered from what the Minister said that the national health is paying something over £500,000 in treatment benefits.
Yes, in treatment benefits.
What was the expenditure this year?
Around £500,000.
Provided or spent?
In the last financial year it amounted to £500,000. It is higher this year.
I gather from what the Minister has said that there is an expenditure of approximately £500,000. Undoubtedly, that is a very big sum of money. There is no doubt at all that if those people are to be maintained in hospitals the hospital authorities will look for five guineas in respect of every person and will endeavour to get it. It is undesirable in a general way that one person should have to go and be maintained at four guineas, which would be paid by the Minister, and that the other person, under machinery of the local authority or through their own means, would be compelled and obliged to pay the other guinea. That is undesirable in a general way. What should be done is that the Minister, who is contributing these large sums on behalf of members of the society to the hospitals, should strike the hardest possible bargain with the hospitals. After all, these hospitals are receiving moneys from a number of sources. They are receiving moneys from other sources.
Public moneys go to these hospitals in different ways and if the Minister is not in a position to reduce the charge below five guineas he ought, as Deputy Norton said, to consider the whole matter again with a view to the payment of the five guineas. The main thing as far as the national health insurance members are concerned is that they should get proper treatment and proper maintenance in hospital but they should not be subjected to this inquiry either from the local authority or from the hospital authorities through their almoners and the machinery of the hospitals.
From July the sick man and his dependents will have 50/-per week. The single man has only 24/- per week and I think it is hardly fair to ask him therefore to pay towards his hospital treatment. There are many little comforts he will require. I think we can very easily agree that the Minister should come to the rescue of a man in hospital even if he has 50/- per week for himself, his wife and two children. I do not think it would be fair to trespass on that 50/-per week because his wife and two children will have to be supported and I do not think the poor patient should be annoyed when he is in hospital with questions as to whether he can pay anything for his treatment other than the national health which is being paid for him in that institution.
Deputy Norton spoke on this matter before and adverted to the fact that when the cost in hospitals went up from two and a half guineas to four guineas he met the difference.
That may be true. Nevertheless, the medical benefits never exceeded £500,000 in any one year up to this and something like this was necessary in order to put some limit to the extension of medical benefits. That is why the change has been made for this financial year but it is done on the clear understanding that any person who has not the means to pay that extra money will have the contribution made by the local authority. I cannot see how anybody can imagine at the present time that if a man has only 22/6 a week the local authority will not come to his rescue. As a matter of fact local authorities are paying for people with much bigger incomes than 22/6 a week and I see no reason why they should not do that in these particular cases. Why should we assume they will not do it?
Local authorities do not come to the rescue of a man who is an insured person.
They are bound to and they should. The local authority is bound to see that if a person wants treatment and cannot afford it he will be provided with that treatment. There should be no difficulty.
Is it not a matter of interpretation as to whether he can or cannot afford it?
That is right.
I think the interpretation should be can he afford the five guineas and not can he afford the extra money.
There is no doubt that no local authority would imagine that a man who is only drawing 22/6 a week could pay £1 out of that towards hospital treatment.
Or even the man with £2 10s. per week.
I do not think any local authority would dispute that. They could not dispute it. Deputy Norton was pointing out to the House the huge funds we have and asking why we should not draw upon them. When one goes back to Deputy Norton's Second Reading speech one sees that he thought we were going to draw upon the funds and he attacked us for that. When I said we were not going to draw on them but that we were going to invest the money and use the interest——
I am afraid the Minister is drawing on his imagination. I never made any reference to that in my Second Reading Speech.
I was under the impression the Deputy accused us of intending to use the funds.
I never levelled any such charge. I take it that is withdrawn now.
Yes, I misunderstood. This is not a new principle. Deputies must be familiar with the medical benefits under the national health insurance scheme. They must know that at all times a man had to pay half the cost of a denture. There was no such thing as the local authority paying part. Admittedly the man was working at the time but nevertheless he had to pay half. If you like, we are extending that principle in a way that is not very welcome to the insured person but we are extending it because the annual amount for medical benefits was growing very rapidly and exceeding £500,000 a year. If we find we have overshot the mark and if we can go back to the five guineas and still remain in or around £500,000, I shall certainly consider that matter. I do not want to make a saving on the £500,000.
I want to ask a question with regard to those hospitals that come within the category of approved hospitals for the purpose of treatment under the national health insurance scheme. I had some cases recently where contributors could not gain admittance to the approved hospitals and because of the urgency of their particular complaints they had to go to a private home or some other institution which was not an approved hospital. They were under the impression that the national health fund or the Minister would come to their assistance in paying for their treatment in these particular establishments. When they came out they were presented with big bills together with medical fees and fees for certain tests that were carried out.
The Minister indicated some time ago that he had under consideration the question of extending the number of approved hospitals. Has anything been done in that respect? At certain periods of the year these approved hospitals are very full and urgent cases have to seek admittance elsewhere. Can the Minister say if anything has been done in that regard?
I remember telling the Deputy we had the question of revision under consideration. We have not completed it yet. I was hoping we might make a regulation under this new Bill.
Can the Minister indicate the lines on which he is thinking? The only approved hospital in Wexford is the county hospital. When that is full urgent cases, such as ulcers and so on, must go to some private nursing home. That is an expensive proposition and no help is given. Does the Minister contemplate including private nursing homes as approved hospitals?
Did the Minister not indicate that the amount of benefit would be paid in future in these hospitals on the Second Reading?
The Minister indicated that it would be extended. Will it be extended to semi-public hospitals and to private nursing homes?
He said he would pay the same amount as was paid in the approved hospitals.
But will that be done?
I think the list has been extended but it has not been finally completed yet. I will let the Deputies know how the matter stands.
I do not think the Minister has met the situation in the way that circumstances demand and I think that is because he does not know how this matter is dealt with by the local authority. When an insured contributor goes to hospital he is tabbed as such and the usual practice is to get the Department or the society to pay the full cost of maintenance, which was at first £2 12s. 6d., subsequently four guineas and now five guineas. That contributor will now be expected to pay five guineas. He may plead that he cannot pay five guineas. He may plead he cannot pay anything at all. He will be told that the Department will pay four guineas but the hospital will look for another guinea and that contributor will be badgered in an effort to get that guinea out of him.
Almoners have certain duties to perform and they are pretty alert in performing their duties. The position up to this was that a contributor could walk out of the hospital knowing the bill would be discharged by the Department. In future that contributor will go out wondering if he can manage to get out without paying the extra guinea. The effort to get that guinea will involve that person parading his poverty before the almoner or some of the hospital authorities. The hospital will want one guinea out of that man's 22/6. If the insured person is a woman she will not even have 22/6. Heretofore, that man could walk out of the hospital with his head up, feeling that his hospital treatment was paid for. He will now have to parade his poverty and plead that he cannot pay this one guinea and will have to try and get away as quickly and as quietly as possible from the almoner or other official whose job it will be to get this guinea.
These hospital fees were not increased from four to five guineas merely for the sake of dealing in fives instead of fours. The hospitals mean to get the five guineas if they can. Their financial position is such that they will say they are acting within reason in looking for the five guineas, but I suggest that their trouble is that they are trying to get this guinea from the wrong people, from an insured person who has no wages while in hospital. That person cannot afford to pay the guinea.
I think the Minister ought to look into this matter again and get some more money from the "kitty" so as to enable an insured person in the future to be able to walk out of hospital with his head as erect as he could hold it up to now. But it is not only in regard to hospital treatment that the Department is breaking from the tradition in the past. Up to now, anybody who wanted an X-ray could get it under the National Health Insurance Society's scheme free of charge. I think there are good reasons for encouraging people to get an X-ray instead of having them going around imagining that this, that and the other thing is wrong with them. In the past, if they were recommended by a doctor for an X-ray, they could get it free of charge through the society or the Department, but an Order recently made by the Minister makes the insured person pay half a guinea for the X-ray in the future. A person who was able to get an X-ray free of charge in the past is going to be required to pay a half guinea in the future. In the case of a person who is out sick, that half guinea is going to come out of the allowance which he gets in sickness benefit. Under this Bill, or under existing legislation, that means that the half guinea will come out of 22/6, so that he will be left with 12/- to fend for himself for the rest of the week.
I think that is unfair, and it is particularly unfair when, in fact, the Minister and the Department of Finance have at their disposal nearly £6,000,000 of the moneys of insured persons. Why would the Minister not allow insured persons to utilise the money in the "kitty" which they have built up for the purpose of getting from it sufficient to enable them to get free of charge in the future what they were able to get free of charge under the national health insurance scheme in the past?
Now, what the Minister has said is true, that in the past people were required to make a contribution towards the cost of spectacles and teeth. I do not put these in the same category as treatment in hospital or an X-ray examination. People can develop fashions in teeth and spectacles, but there is no question of developing fashions about going into hospital for treatment except where it is necessary. I think that the Department should, from the contributors' fund at their disposal, meet the additional cost as it was met in the past. I would strongly urge on the Minister not to allow Department of Finance considerations to operate in this case. There is plenty of money there, and I can hardly imagine the Minister himself being reluctant to use it. It is the insured person's money, and I suggest that it ought to be utilised for the purpose of exempting a person from paying these heavy imposts under, what is after all, a relatively low rate of sickness benefit.
I am putting Section 14.
Has the Minister nothing more to say?
I do not see that I can say anything more. I have pointed out, over and over again, that the people the Deputy has in mind are entitled to free treatment if they never had national health insurance. It is ridiculous to talk about such persons being asked for a guinea. If they had £3 per week, they would not be asked for it. There is no use in making the case that people are being asked to pay a guinea out of 22/6. That will not happen if the local authority is doing its job. If the Deputy was in my place, and was paying out grants to local authorities, he would know, as I know, what local authorities are spending in regard to these benefits.
What I did was to refer to the methods of administering these things.
There is no use in making the case which the Deputy did. These treatment benefits were there before amalgamation took place. Some societies had them and some had not. Generally speaking, they did not come in until 1942. Since 1942, they have been growing gradually. In the last four years they have doubled. In the first year in which Deputy Norton took over, they were about half what they are at the moment. They were growing at such a rate that we had to make some limit. We had to say, as regards those who could afford to pay, let them pay the guinea extra, and that as regards those who could not afford to pay the local authority would pay for them.
I think that £4 4s. per week was not a bad contribution to make for hospital treatment for a sick person under the national health insurance scheme. I think that when it was agreed to make it £5 5s. that it was really an incentive to the hospital authorities to get after the patient to try and get the guinea from him. My idea is that the hospital authorities should be told that the only contribution we can make for an insured person is £4 4s. per week. I should like to know how it came about that the charge should be £5 5s. My opinion is that, when you agreed that it should be £5 5s., the hospital authorities were bound to look for the extra guinea from the insured person. I think it should be pointed out that the National Health Insurance Society is prepared to contribute £4 4s. a week for an insured person while in hospital. I do not know how the £5 5s. a week was arrived at.
That is what the hospitals are charging.
Is there any danger that, having given them £5 5s., they will not make it £6 6s.? Is there any reason to think that they will not put the figure one guinea above what the Minister wants to pay?
I do not think there is any danger of that. The Department of Health sanctioned £5 5s. a week for the voluntary hospitals and the Department of Social Welfare said they could not afford to pay the £5 5s. There is a conflict between the two Departments which I cannot settle.
If the Minister had been a little more definite with regard to the practice of local authorities in their treatment of the type of patient that we have been discussing, I would have been inclined not to pursue this discussion on Section 14. Would the Minister not make some inquiry from local authorities to see in what way they treat those people who have no income but this 22/6 a week, because I think that, as soon as a local authority gets to know that it is a national health patient, it will waive all claim as regards responsibility for that patient and leave the case to the National Health Insurance Society. It may be the duty, legally, of a local authority to provide free treatment for such people, but in practice I do not think they do it. Perhaps the Minister would consider making a spot check on certain local authorities to find out exactly what is their practice.
There are many Deputies members of local authorities. There are hundreds of patients in the hospitals every week in the year who do not pay anything at all and are unable to pay. Do you expect that the local authority will say: "We are prepared to meet the bill for so-and-so because we know that he has no means and can pay nothing." How was this five guineas arrived at? You say the hospitals are charging that for the patients. It would be much better if the Department of Social Welfare were to say: "We cannot pay the £5 5s. a week. We are prepared to pay £4 4s. a week." Then they would not be after a man or woman looking for the £1 balance.
Is it not the position that every bed costs up to £6 a week in practically every hospital?
Granted.
If a person goes into a local authority hospital and says that he cannot pay five guineas a week, the question will be referred to the home assistance officer. The Minister has explained that if a person is getting only national health benefit that would be sufficient guarantee that he is not able to pay.
Is this a fair interpretation of what the Minister has said? As Minister for Health he is authorising the hospitals to get five guineas. As Minister for Social Welfare he says: "So far as I am liable for insured persons, I cannot pay more than four guineas." Therefore, he says to the insured person: "You are liable for the other guinea." That is the position up to to-day. The Minister says to-day that so far as the insured person is concerned he cannot be expected to pay a guinea out of 22/6 and he cannot be expected to pay it out of 24/- and in fact he could not pay a guinea out of 50/- per week. Is that the Minister's view?
Yes.
Then the best service the Press could do is to tell the insured persons to-morrow morning that the Minister for Social Welfare here this evening said that the insured persons could not be expected to pay hospitals one guinea per week out of either 22/6 or 50/- and that they are not expected to pay. That is the only protection to give these people and that is what the Press should do to-morrow and consequently make sure that these people are not made liable to pay one guinea per week out of these small sums of money. If the Press will render that service to-morrow, it is as good as an amendment by the Minister to this Bill, because the insured persons will not be salted to pay the guinea.
I think there is a lot to be said for that. Let the hospitals get the money, if they can, from the local authorities, if they can establish a right to get it from the local authorities but, if the insured contributors know that there is no obligation on them to pay this guinea out of the 22/6 or the £2 10s., there is no problem about the section at all.
On the other hand, you may have a case where there will be £30 or £40 going into the house and only one person is sick. I am sure the local authority will not agree that in that case the person should not pay the money.
As long as the insured contributor is kept free, that is the main thing.
I move amendment No. 3:—
In sub-section (1), page 14, line 24, to delete "(subject as hereafter provided)."
"(Subject as hereafter provided)" is not necessary because unemployment benefit or disability benefit will not now be paid in any circumstance over pensionable age, that is over 70. Therefore, it is not necessary.
I move amendment No. 4:—
To delete sub-section (2).
Sub-section (2) reads:—
"A female person whose employment is mainly in agriculture or domestic service shall not be entitled to unemployment benefit."
The amendment proposes to delete that sub-section. The method proposed under sub-section (2) of the section as it stands is likely to produce difficulties administratively. It will make necessary the imposition of a long term test to determine whether or not a worker should be regarded as employed mainly in agriculture or domestic service and this would be a difficulty in such cases. It is better to solve the problem, it is thought, by amending the contribution conditions for disability or unemployment benefit contained in paragraph 1 of the Fourth Schedule and these conditions are amended by providing that, where a claim to unemployment benefit is concerned, contributions at the special rate of 2/- applicable to female agricultural and domestic workers do not count. This puts employment of that nature outside the scope of the scheme as far as unemployment insurance is concerned. So that the amendment of the Fourth Schedule is considered a better way of dealing with this, taking this sub-section out.
What is the effect of leaving in sub-section (2)?
It is thought that it will be administratively difficult because it says "mainly in agriculture or domestic service". It is thought that there would have to be perhaps a long waiting period to determine what employment she is mainly in. It is considered better to take it out at this stage and to amend the Fourth Schedule by making the benefit depend on the contribution.
What is the increased contribution, can the Minister say? It has gone to 2/-?
2/-. With the unemployment benefit, 3/4—the difference between 2/- and 3/4.
I did not get the Minister right. What is the insured person's contribution at the present time? I thought the Minister said just now that this will mean that her contribution will be 2/- per week.
Yes; the contribution will be at the special rate of 2/-. That is what it will be without unemployment benefit.
What is it proposed to make it?
That is what it is proposed to make it under the Fourth Schedule.
What would it be with this sub-section left in?
3/4 if unemployment benefit is included.
Amendment No. 5 is ruled out of order.
Has the Minister any views on that section as far as my amendment is concerned?
The Deputy could raise that on the section, as amended, not now.
I have in mind casual workers who come badly out of this section both in respect of sickness benefit and unemployment benefit. It it wrong that when a man falls ill his benefit should not date from the date at which he falls ill. Up to now he was not entitled to benefit for the first six days but under this Bill that is reduced to three days. I do not know what the justification is for the three days. If a man falls ill, he loses his wages and is reduced to 22/- or, if he has a family, 50/- a week. It is wrong that the benefit should not start from the date on which he becomes ill. That is from the illness point of view.
Take then the case of the unemployed man and I am particularly concerned about casual workers, particularly dockers and builders' labourers. If a casual man gets three and a half days' work in the week, he will not get any benefit from the unemployment fund and that is particularly so in the case of a docker. He is employed morning after morning and some weeks he gets three and a half days and other weeks four days' work, but there are quite a big number of dockers who never get more than four days' work in the week. He is more likely to get three days the whole year round, but, assuming he gets four days in the week, he gets nothing at the labour exchange, although he signs on there, because he does not know how long he will be unemployed. Totting that up for the whole year, it means that in the case of such men, there are 104 days, or 17 weeks and two days, in the year in respect of which they get no unemployment benefit whatever. That is a grave injustice against these men.
We had hoped that that position would be set right in this Bill and it was the reason for my putting down the amendments which have been ruled out of order. I appeal to the Minister to rectify that situation. The question of social justice comes into it. Why should we penalise a worker because he is a worker and deprive him of sickness benefit until he has been ill for three days? If he can return after being ill for three days, he gets nothing at all. The same applies to the casual worker. There are a number of men engaged in the building industry whose only security in that trade is that they get an hour's notice of unemployment —they can be dismissed after one hour's employment. The only guarantee the docker has is a day's wages when he starts in the morning. If a man is employed on a weekly wage, he may be off for a week or two and in many cases the employer pays him full wages while he is out ill.
Every man in the State service who falls ill gets his full week's wages while ill, but when it comes to the ordinary worker and particularly the worker who is subject to casual employment, he must register for four days before he gets anything at all and he will get only one day's illness benefit after being out for four days. From the humane point of view, it is unfair that any class of worker should be unemployed for 17 weeks and two days in the year and that he should receive no benefit whatever from the State in respect of that period of unemployment. I appeal to the Minister to rectify that position. There is nothing unreasonable in asking that that be done.
If the Minister cannot see his way to abolish this restriction altogether, perhaps he would agree to reduce it to two days. That would be a great benefit to certain dockers in Cork who work only about three days in the week.
I agree with that suggestion. I feel that when a man goes sick and gets nothing for the first three days of his illness, it is an incentive to him to stay sick. Many a person may be sick for two or three days and may then be fit to return to work but, in order to draw benefit, they have to remain sick for a week. I cannot see any sense in that and never could. I think that that restriction should be removed and once a man becomes sick—it is not his fault that he becomes sick—he should be entitled to draw his benefit as from the day he is forced to leave his duty.
The present law in relation to unemployment insurance is that a person must be six days unemployed before drawing benefit. The period in respect of national health insurance is three days. This clause makes the period three days for both and it is, therefore, a considerable advance on the present position. To cut it out completely would make administration very difficult, because many men are sick with a cold for a day or two days and then go back. In the same way, they might be laid off for a day or two and it would be administratively very difficult to cover all these cases for individual days. It would also be very costly and would probably have the effect of making the contribution higher. Everybody will agree, I think, that a man who is in fairly regular employment should be able to provide for a contingency of that kind—sickness for one or two days occasionally.
The cases mentioned by Deputy Hickey and Deputy McGrath are different. That is a particular form of employment and these men are nearly always idle for a couple of days in the week. I do not think that should be dealt with by means of unemployment benefit; it should be dealt with in some other way and is being dealt with to a great extent in another way. In fact, I am told—I do not know exactly what the position is—that dockers get a very much bigger wage, comparatively speaking, than other workers because of the casual nature of their employment. If such a man gets four days' work he gets what may be equivalent to a full wage in another employment, and I think that is the proper way to deal with it.
The shipping merchants are not as soft as that.
Everybody knows that they get a bigger wage than is provided in most other employments.
That is on account of the nature of the work—not its casual nature.
They get it, anyway, and they do not have to work six days a week like the ordinary worker. I think it should be dealt with in that way and not by means of unemployment insurance.
There are two problems here. Where a person is ill for a day or two days, undoubtedly there can be considerable administrative difficulty, but suppose a person is ill for a period of ten days? Is it the position that the first three days are knocked off and do not count?
That is right.
If a person is ill for a continuous period, the first three days should be included, and he should receive benefit for every day he is ill. I can see that there is a difference where a man is out ill for one, two or three days and stops at that, but if he is ill for ten days, he should not lose his benefit for the first three days, as I gather from the Minister is the position.
That is the case.
I would make the case that, if he is out for a period which would entitle him to benefit now, the first three days should be included for benefit purposes.
The purpose of social security measures is to provide for the worker at times when he cannot receive a wage. If every one of us here were to speak his mind, he would admit that any one of his constituents who ever approached him with regard to national health insurance complained bitterly about these three days for which they are not paid. Every person in the House has had that experience. Deputy Cowan's solution would be a sort of compromise to which none of us would be inclined to agree. The Minister talks about administrative difficulties and cites the example of the man who has a cold for a day or two. He says it would not be right to make a payment to a man in respect of the one day, or the two or three days. I do not think there could be any case there for malingering, because the medical officer appointed by the Minister is charged with the responsibility of certifying that the man is incapable of working. If we are to accept social security in respect of sickness and unemployment, we should accept it in relation to every single day a man finds that he is not able to work, either because he cannot get it or because he is unable to work, and the Minister should agree to include these three days as payable days.