I move:—
That a sum not exceeding £7,687,700 be granted to complete the sum necessary to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1955, for the Salaries and Expenses of the Office of the Minister for Health (including Oifig an Ard-Chláraitheora), and certain Services administered by that Office, including Grants to Local Authorities, miscellaneous Grants and Grants-in-Aid.
In common with my colleagues who have moved Estimates in the House in the last week or so, I am to-day introducing an Estimate prepared not by me but by my predecessor in office, for the sums needed by my Department for the current year. I have too recently taken up office to have had the opportunity of examining fully the services covered by the Estimate. I intend, therefore, to present the Estimate to the House as it stands, giving merely a brief comment on the working of the main health services during the past year.
I propose in the first place to review some of the main vital statistics for the previous year. The figures quoted for 1953 are provisional but figures for earlier years are final.
The birth rate per 1,000 of the population for 1953 was 21.1 as compared with 21.9 for 1952.
The marriage rate also fell slightly from 5.4 in 1952 to 5.3 in 1953.
There was a slight decrease in the death rate from 11.9 per 1,000 population in 1952 to 11.8 in 1953.
The infant mortality rate, at 39 per 1,000 live births, was the lowest yet recorded for this country. It compares with a figure of 41 for 1952 and an average of 47 for the five years to 1952. The maternal mortality rate also improved from 1.4 per 1,000 live births in 1952 to 1.2 in 1953.
It is gratifying to find that the downward trend in the mortality from T.B. has been maintained. The rate for 1953 —40 per 100,000 population—was the lowest yet recorded. It compares with a rate of 54 per 100,000 population for 1952 and is exactly half the rate for 1950. That there is still room for improvement is shown by the rates recorded for other countries; in the Netherlands for example, a rate of 16 per 100,000 population and in Denmark a rate of 14 were recorded in recent years.
The death rate from cancer was 143 per 100,000 population as compared with a similar figure for 1952. The heavy mortality from cancer emphasises the need for improving to the maximum possible extent the facilities for diagnosing and treating the disease.
There were 35 deaths from measles as compared with 52 in 1952; 59 deaths from whooping cough as against 86 in 1952; and scarlet fever deaths fell to three, from ten in the previous year. There was also a decline in the deaths from diphtheria from seven in 1952 to three in 1953. I shall have something further to say about this disease later.
Deaths from influenza increased from 238 in 1952 to 476 in 1953 and deaths from poliomyelitis from 13 to 33. Deaths from gastro-enteritis among children under two were also higher than in the previous year, this disease being responsible for 185 deaths in that age-group as compared with 160 in 1952.
We again had a clear record in regard to smallpox.
I now propose to review briefly the work done in connection with the statutory health services—using the term generally—during the past year.
Medical assistance services were further improved during the year by the provision of new buildings, to which I shall refer briefly later, and by the improvement of equipment in existing hospitals, etc. During the year the former fever hospital premises at Cork Street, Dublin, became available for other purposes and it was decided to use it to accommodate a large number of the ambulant persons in St. Kevin's Hospital. At the same time the Dublin Board of Assistance, having acquired other premises from the authorities of the Mendicity Institution, was adapting them for use by male casuals who are now housed in portion of St. Kevin's. The transfer of these persons from St. Kevin's in the near future will contribute substantially to the rehabilitation and improvement of that institution and to the improvement generally of the services which the board provides. Public assistance authorities throughout the country continued their efforts to provide special accommodation for particular classes as was done by the Dublin Board of Assistance. Side by side with the more spectacular building programme, the authorities mentioned continued the improvement of the services by providing additional staff where needed.
I have referred to the very greatly reduced death rate from T.B. Up to the present time a large part of the effort of the Department of Health and of the local authorities administering the T.B. services has been devoted to providing sufficient beds for sufferers from the pulmonary variety of the disease. An additional 350 beds became available during the past year, mainly at the Western Regional Sanatorium in Galway and in Ardkeen Chest Hospital, Waterford, and so far as can be foreseen the time is now near when a bed will be available almost immediately for every pulmonary patient in need of treatment in a hospital or sanatorium. In future, greater time and attention can be devoted towards the expansion and development of the field services, particularly the tracing of contacts of cases which come to light and the preventive measures represented by tuberculin testing, B.C.G. vaccination, and mass-radiography. The National B.C.G. Committee and local authorities which operate their own B.C.G. schemes performed over 56,000 vaccinations in the year ended 31st March last. The National Mass-Radiography Association and the Cork County Council which operates its own mass-radiography scheme between them X-rayed over 190,000 persons.
It should not be necessary for me to stress that all diagnostic and treatment facilities for T.B. are freely available to every citizen and that I, my Department and the health authorities are only too anxious to see them availed of to the fullest extent to ensure that treatment is commenced at the earliest possible stage in the development of the disease.
The scheme of cash allowances for persons suffering from infectious diseases continued during the year. The primary purpose of the scheme is to encourage people with certain infectious diseases, especially T.B., to undergo the treatment needed for their conditions by relieving them of anxiety as to their own maintenance or the maintenance of their families while they are getting treatment.
I find that some noteworthy improvements were made in the mental hospital services during the past year. In several mental hospitals, schemes of reconstruction are in progress, while in other cases planning is actively proceeding. Work started on the provision of 328 extra beds by the Grangegorman Mental Hospital authority. Overcrowding in mental hospitals is acute in a number of places and it is hoped that the additional patient and staff accommodation which will be available when these works are completed will relieve the problem very substantially.
The various modern forms of psychiatric treatment are now in general use in district mental hospitals. The extension in the use of these treatments has been helped by the fact that medical and nursing staffs in the hospitals have been increased considerably in recent years. The better facilities for the reception of voluntary and temporary patients, and the development of active treatments have given a great impetus to the treatment of mental illness in the early stages, when, of course, the prospects of quick recovery are most favourable. This is reflected in the increased receptions of voluntary and temporary patients, the numbers of whom have risen roughly three-fold between 1947 and 1953. The numbers of discharges of such patients are also very satisfactory. A gradual advance is also being made in the provision of facilities for occupational and recreational therapy in mental hospitals. In most of the district mental hospitals, at least 50 per cent. of the patients are provided with suitable employment. Upwards of 70 per cent. take part in the indoor and outdoor recreations available. Both forms of therapy are found to help considerably towards recovery in many cases.
Approximately £3,650,000 was paid out by way of grants from the Hospitals' Trust Fund for the building of hospitals during 1953-54. Among the major hospital works completed during the year were the new fever hospital at Dublin with 280 beds, and the new county hospital at Manorhamilton. Work commenced during the year on a large number of projects. The most important of these were a new unit at the Meath Hospital to provide 80 beds, a new nurses' home at Mercer's Hospital, Dublin; a new orthopadic hospital at Kilcreen, County Kilkenny; and the provision of 328 extra beds at Grangegorman and Portrane Mental Hospitals. The work of converting premises at Celbridge to a mental defective institution was also started.
A number of large hospitals and hospital buildings were at a very advanced stage of construction by the end of March and the majority of them should come into operation during the current financial year. These include the regional sanatoria at Galway, Cork and Dublin; Our Lady's Hospital for Sick Children at Crumlin, Dublin; the new orthopaedic hospital at Gurranebraher, County Cork; St. Luke's Hospital, Dublin; the Limerick Regional Hospital; the new nurses' home at the Mater Hospital, Dublin; the main block of Galway Regional Hospital and the major extensions to the mental defective institutions at Drumcor, County Louth and Lota, County Cork.
Out of a total of just over 1,000 dispensaries and dispensary depots in the country, local authorities have indicated that they propose to replace approximately 400. From May, 1952, when grants for the erection of new dispensaries were first promised, up to the 31st March last, 65 new premises had been provided, and it is hoped that a further 100 will become available during the current financial year. This rate of progress should see the finish of the dispensary replacement programme within a few years. Seven county clinics in all have been completed and seven others now in process of building should be finished before the end of the current year. In three other cases the stage of inviting tenders has been reached, and the planning of the remainder included in the county clinic construction programme is proceeding.
Expenditure on local authority health services rose from £5,650,000 in 1947-48 to over £11,500,000 in 1953-54. The Exchequer is now bearing 50 per cent. of the cost of these services.
The fact that health services are costing the ratepayer and the taxpayer such large sums prompts me to offer some advice at the risk of incurring the displeasure of those who hold that it is wrong that a Minister for Health, a politician and a layman, should usurp such functions.
I have said earlier that there was no case of smallpox in this country in the last year. In fact, we have had no native case of it for many years. I have also given the number of deaths from diphtheria in the last year. The number of cases of this disease and the number of deaths from it have declined enormously in recent years. This happy position, competent and widely accepted medical opinion assures us, is attributable to the widespread vaccination against smallpox and immunisation against diphtheria. The same opinion warns us, however, that we cannot hope that the present freedom from the one disease and relative freedom from the other can continue unless parents continue to see that their children are protected by vaccination and immunisation. The trouble involved in bringing a child to a doctor to have these procedures carried out is a very small price to pay for the immunities they confer. The family doctor will be glad to do what is necessary or the health authority will provide the service free for anybody who wants it. I would therefore appeal to all parents of young children to make a special point of seeing that all their children get this protection.
There is probably no adult in this country who has not witnessed the misfortune which can descend on a family through T.B. It is not a hereditary disease—anybody in an unprotected state can contact it from close contact with an infected person and we do not always know who is infected and who is not. Every one of us who has the least suspicion that he may have been unfortunate enough to contact it has the duty of going for a check-up in his own interest and lest he should be the cause of passing it on to his relatives, his colleagues at work, or his friends. The facilities for such check-up are available to everybody. In addition, medical science has discovered a means of providing a considerable measure of protection against it—by B.C.G. vaccination. If all children and young adults were given such protection, the saving in suffering, in economic distress and in the expenditure of public moneys on the hospital services would, in the course of a relatively few years, be enormous. I would appeal, therefore, to all Deputies to co-operate fully with health authorities and the voluntary agencies set up to deal with particular aspects of the tuberculosis services in encouraging the public and particularly the parents of children and young adults to avail of the services made available for their protection.
I indicated at the beginning of my speech that I had not yet had an opportunity of examining the health services fully. I do not intend, therefore, to make any statement about future policy on numerous important details of those services. I will, however, say that it is my intention, and the Government's to obtain and maintain in the health services of this country a standard as high as that which applies in other comparable countries. Everybody in the House will be with me in declaring this intention; the means which should be taken towards securing this end are receiving my active consideration at the moment and I hope to be able to deal more fully with the matter in the course of the discussion which will take place on the Health Bill in this House in the immediate future.