I move amendment No. 1:—
In page 2, line 32, to add after "Minister": "provided that no person shall be refused any specialist service on the grounds of mere inability to pay such charge."
I have tabled this amendment, on this stage of the Bill, to the first section of the Bill. The reason for this amendment will, I think, be apparent to Deputies who took part in the debate on the Committee Stage. In order to explain the reason for it I think I should remind the House that under this Bill the Minister proposes to interfere with the principle upon which the Health Act of 1953 was accepted by Dáil Éireann. That principle was that, under the Health Act of 1953, all eligible persons would henceforth be entitled to free specialist facilities.
I would like to remind Deputies that, under that Act, little or no charge was intended to be made in regard to the provision of free medical services for the poorer sections of the community. A big departure was the provision in the Act that each family doctor, attending an eligible person under the Health Act, would have available on behalf of his patient the full range of specialist facilities in our leading teaching hospitals, without any charge whatsoever. Of course, as Deputies will remember, the Bill having become an Act towards the end of 1953, it was brought into operation by the then Minister for Health, the present Minister for Finance, who left office without having devised a means whereby these free specialist services could in fact be provided for eligible persons.
It then became my responsibility, as his successor, to see in what way such services could in fact be provided. On 1st April, 1956, just some 15 months ago, I was able to make the necessary Orders, providing that these facilities would henceforth be available to each eligible person enumerated and specified in Section 15 of the Health Act of 1953. I regarded that as a step forward in the provision of necessary services for those in need. I regarded it as an important step forward in the diagnosis of ailments, individual ailments of different people who might be suffering, and an encouragement to the family doctor to give improved treatment to his patients. The steps taken provided the full ranges of the specialist services in our lending teaching hospitals for each eligible person. If an X-ray were required, the person merely had to present a reference from his family doctor and whatever was required in that connection was provided without charge.
If the patient required to see a consultant physician or any other consultant on the staff of any teaching hospital, he was entitled to do so, again merely on the reference of his family doctor. In making this provision, I was fulfilling a pledge which I made to Dáil Éireann on the occasion of the passage of the Health Bill of 1954, a pledge by which I undertook to see as quickly as possible that all the services envisaged in the Health Act of 1953 would be provided in fact and not merely on paper.
In these circumstances, I felt some concern that my successor as Minister in a Fianna Fáil Government should have brought in a proposal whereby the idea of free specialist services for needy persons would be destroyed. I felt some concern and dismay that a member of the Fianna Fáil Party, after the passage of less than four years, should come into this Parliament pleading the case that the Fianna Fáil Minister in 1953 had acted unwisely and wrongly and that it was in some way wrong to provide for the needy sections of our people necessary specialist services, unless some payment were made for them.
As Deputies will recollect, we debated on the Committee Stage the merits of the proposal to impose a charge contained in this Bill. During the course of that debate, I and Deputy Dr. Browne and other Deputies raised the question of what would happen if the person needing and seeking this specialist service was, in fact, unable to pay. I think it was Deputy Kyne who queried the Minister as to whether it was his attention, to be translated into regulations, that the charge sought would be paid before or after the service was provided. The Minister informed the Dáil that it was his intention, so far as he could make it operative, that these charges would be paid in advance and, accordingly, the position confronts this House that it is the Minister's intention to provide, when empowered, on the passage of this Bill, by resolution, that no person needing the services of a specialist may get such service unless, first of all, he planks down the money.
I would say to Deputies that whatever differences we may have with regard to the best means of providing health services for individuals in this State, surely there should be no disagreement amongst us that a person in need financially should always be provided with the medical aid he requires. In countries which we have been inclined to regard as being somewhat backward in the provision of social services it is, nevertheless, recognised that a sick person must, first of all, be treated before any question for payment can arise, but not, apparently, under the present Fianna Fáil Administration.
According to the Minister, these services will not be provided, if he can prevent it, until, first of all, the charge specified in the regulations is paid. Not only do I think that wrong, but I think it a most unfortunate, retrograde step. Further, whatever regulations may be made, whatever ministerial policy may be laid down, whatever directions may be issued, I am quite certain that the innate kindlness of our people will ensure that necessary services will, in fact, be provided whether or not a payment can possibly be made. It is in order to ensure that we should not have on our Statute Book such a retrograde section of an Act of Parliament that I propose this amendment. I am certain that there is no Deputy in the Fianna Fáil Party or in the House who will cavil in the slightest at the amendment I suggest.
I suggest that there be added to this section, agreeing as we must, since the House has decided, that the charges shall be imposed, a provision that no needed service shall be refused merely on the grounds that the person seeking the service is unable to pay. I will exemplify what I have in mind only by reminding Deputies of cases within their own experience. A person has some health trouble, perhaps a pain or an ache or something of that kind and he eventually summons up courage to go to his doctor. His doctor, having examined him, says: "You are all right, but I think it might be wiser to have an X-ray examination, just to put your mind at case."
If the present section is not amended and such a person finds himself unable to provide the sum of 7/6, then it is the Minister's intention, as he said on Committee Stage, that such a person will not get the X'ray examination he requires. I think any of us would say that that is wrong and all of us will agreed, if we were free to do so, that no needed specialist service of any kind can be refused by any health authority merely on the grounds that the person is unable to pay.
If we are to accept the principle of imposing a charge, we can well understand a health authority, speaking through the county manager, saying: "That person could well provide 7/6, if he ceases smoking for a day or two, if he did not go backing horses or dogs, or if he did not drink pints with his friends in the ‘local'." There may be a case in which the inability to pay does not arise merely from lack of means. In my amendment, I give to the Minister the right still to say that in those circumstances the person is not deserving, if the Minister wants to adopt that line, I would not agree with it.
What I propose is the very minimum, the smallest provision that can be made. Whatever the rights and wrongs of individual conduct may be, no health authority should be entitled, merely on the ground of lack of means, to refuse a medical service which a doctor thinks a patient of his requires. I urge on the Minister as strongly as I possibly can that an amendment along these lines should be accepted. We should not permit this Bill to pass from this House containing the possibility, no matter how small it may be, that an official of a health authority may be empowered, merely because a person a needing a medical service has not the means at the time, to refuse such service. It would be wrong that that should happen. My amendment is reasonable. It in no way impairs or takes from the change the Minister seeks to impose in the operation of the Health Act, 1953, but it preserves the rights of a person who, temporarily, may be unable to pay.
I would ask the Minister and, if the Minister is unable to agree, I would appeal very sincerely to Deputies in his Party to regard this amendment not as something tabled by an Opposition Deputy to a Minister's Bill, but as something which we should incorporate in this legislation.