I move:
That Dáil Éireann is of opinion that existing health services have been proved to be inadequate, and that in their place there should be provided a comprehensive health service based on the principles of insurance which will extend to 85 per cent. of the population, and which will provide without charge an adequate medical service with free choice of doctor, free hospital, specialist and diagnostic services and which will remove the necessity for medical cards for all those within the scheme.
This motion, while standing in my name, has been tabled by the Fine Gael Party. It is put down in a responsible way to direct public attention to a very definite social problem. During the recent general election, the Fine Gael Party announced their health policy, which advocated the introduction of a health insurance scheme extending to 85 per cent. of the population. We were met in our campaign by the Minister for Health representing the Fianna Fáil Party who fought the election on the basis that the Fianna Fáil Health Act, and the Fianna Fáil health policy as enshrined in that Act, were adequate for the needs of our people.
The Minister went on the radio on 22nd September and said that the health services were being provided under the Fianna Fáil Health Act in the most economical and equitable way possible. A few days later, at Donnybrook on 27th September, he declared that the Fianna Fáil Health Act, 1953, was the most economical and fair way of providing a comprehensive health service for our people. In that sense and in that way, the issue was therefore knit. The Fianna Fáil Party declared in the last election that the Fianna Fáil Health Act was a good Act, providing economically a fair and equitable health service for our people, we on our part contending that it was not an equitable measure and that in fact it did not provide for our people the health services they required. I am not going to discuss the results of the general election but I assert that the majority of the people are dissatisfied with the services at present administered under the Health Act and that the Fianna Fáil Party and the Minister have failed to satisfy the people that this urgent problem of providing adequate health services can be solved under the present health policy.
Our motion is based on the initial premise that present health services have been proved to be inadequate and I want to mention a few things to vouch that expression of opinion. I would list as defects in the present services a number of things. First, under the Fianna Fáil Health Act of 1953, there is provided a general medical service for poor people. This is a general practitioner service available for the sick poor under general practitioners outside hospitals. This service is known as the dispensary system of medicine. It is enshrined in Section 14 of the Health Act but that section is merely a re-enactment of similar provisions contained in the public assistance statutes of 1939 and amendments thereto.
The dispensary system of medicine was first introduced into this country 110 years ago under an Act known as the Medical Charities Act, 1851. It was a famine relief measure introduced at a time when plague and starvation and famine were the lot of our people, when thousands and thousands of them were being buried in common graves and when disease and plague were decimating our population. At that time, in the middle of the last century, a purse-proud imperial Government in England, actuated by the notions of public charity that then existed—and the bite of charities in those days was very sharp and cold indeed—decided to provide an emergency medical service for the pauper dying Irish and so the dispensary system of medicine was born.
Dispensaries were set up; doctors were paid to go out among the poor Irish and stay there, supervised by dispensary committees, to dole out bandages and medicine bottles and provide an emergency service if a person was sick and dying, provided the person who sought the assistance could prove himself to be a pauper. A person had to establish to the satisfaction of a committee designated by the ratepayers of the area that he was unable, by his own industry or other lawful means, to provide for himself. If he could prove that, the doctor attended him and he got a spoonful out of the medicine bottle. That is the dispensary system of medicine.
Are Deputies on the opposite side concerned to know that that system of medicine, unchanged in any particular, in the slightest way, is the system of medicine which we today provide for the poor people of this country? It is re-enacted in Section 14 of the Health Act unchanged in the slightest and today one of our citizens who may be underprivileged, who may not have the means available to the majority and who requires medical attention, if he is to get it under the Fianna Fáil Health Act, must first prove himself to be a pauper. He must establish to the satisfaction of a local authority, acting through its officials, that he is unable—it does not mean partially able or not well able, but totally unable—by his own industry or other lawful means, to provide for himself.
Is it any wonder that our people find it difficult to prove themselves to be paupers? Is it any wonder that that there is concern about medical cards and registration when in the year 1961 we are trying to operate the outmoded principles of public charity of the last century? That is one result of the dispensary system. Involved in it, of course, in establishing the condition of poverty necessary to enable it to act, is a strict investigation as to means. An unfortunate poor person must subject himself and his family, his sons and daughters, his in-laws, his uncles and aunts, every connection, near or distant, associated with him or his family, to investigation as to their means, what money they earn, what land they own, what chattels they may have available to them. He must disclose all that in order to get on the medical register and be attended by the dispensary doctor. The Minister for Health declared at the last general election: "This is fine; this is providing the most economical and equitable health service that it is possible for us to provide." Having done all this, under the present system, what does the poor person get? He gets the services of one doctor. There is no choice of doctor available. He must avail himself of the services of the dispensary doctor—a man who is appointed to a particular dispensary post, who, I am sure, does his best in a very dedicated way to work a system which is outmoded and out of date. There is no choice of doctor.
It may be understandable in the remote areas in the country, in the places where there are not centres of population, that a multiplicity of doctors would be out of the question and a choice of doctor might be difficult, but, in the centres of population, in this city, in the city of Cork and in other centres throughout the country where brass plates jostle brass plates, along through Drimnagh and elsewhere in this city, is it not astounding that a poor person to whom the State says: "Yes, we owe a duty to provide for you a free medical service" when he wants to get a doctor, must pass doctor after doctor right down one street and another street and must go to the one man designated as the dispensary doctor in the area?
Of course, this leads to a poor medical service, which is not the fault of the doctor. In many cases, such a dispensary doctor has perhaps 2,000 people on his list. He is working hard from morning until night. If a person on his register is in fact ill and requires a number of visits throughout the day, the doctor has not the time to do it. The result is that an ambulance is sent for and the person is sent into hospital. Therefore, the dispensary system leads to a poor medical service and to a high hospitalisation rate.
The fact is that up and down the country a poor person who is sick, to the extent that he is not just upset temporarily but genuinely sick, is never treated at home. He is sent to hospital. It follows from that that under the dispensary system of medicine, there is not provided what should be provided: there is no system of caring for sick people in their homes. The dispensary doctor in most cases acts merely as a conduit pipe from the home to the hospital. He is merely the referring agent of the local authority, referring the person concerned to hospital.
That is the system. What does it cost? The Minister for Health said during the general election: "These services are provided in the most economical way." Perhaps he had the cost of the dispensary service in mind when he said that. It extends at the moment to 800,000 people, 30 per cent. of our population. The total cost at the moment is £1.3 million. Consider the cost of running this State —£140 million. We spend on the sick poor of this country a trifle more than £1 million a year. Had the Minister for Health that in mind when he said: "This is the most economical system"?
A trifle more than £1 million a year is provided by this State for the care and treatment of unfortunate sick people. That £1,300,000 includes the doctors' salaries, the upkeep of dispensary buildings, all the administration involved in the dispensary system. All that is in the £1,300,000. How much of it goes in medicines to the unfortunate person who is ill? I do not know what the present figures are but last year the actual sum provided for medicines for sick people worked out at something around 4/- per head per year. Perhaps it is a little more now. Maybe it is 6/- per head per year. That is what this State provides for giving medicines and drugs to sick poor people.
There it is, and that is the dispensary system of medicine. I say that defect No. 1, standing out clearly in the present health services, is the fact that medical care for poor people is provided under the dispensary system of medicine. There are other defects in the present system and the next one I shall deal with is perhaps just as grave: certainly its effect on the general public has been very severe and very intense. I refer to the fact that, under our present health services, no medical care whatsoever is provided for persons who do not qualify for medical cards, that is, the vast majority of persons with limited means.
I do not know whether people will recollect that when the Fianna Fáil Health Act was paraded before the voters in the 1954 general election, many people formed the opinion, at least—whether it was actually said to them or not, I do not know—that under this scheme there was to be a free medical service for everybody whose income did not exceed £800, for all farmers up to £50 valuation and for all insured persons. Indeed, perhaps enthusiastic and zealous, Fianna Fáil supporters made speeches to that effect not understanding what, in fact, was involved in the Health Act of 1953. We know now that, under this fair and equitable policy that the Minister for Health stands over, there is no health service for a person who cannot prove himself to be a pauper, who cannot get on the medical register. There is no medical service outside hospital for such a person. That person must pay for a doctor. He must go to the chemist's shop and buy whatever drugs or medicines are necessary to cope with an illness in the family. Without any assistance whatsoever from the State, that person has got to face up to the hazards, the dangers, and the problems associated with illness in the family.
I suppose it is wrong to say that is a defect in the present health service. It would be more correct, perhaps, to say that it is a glaring omission and one which renders the entire service absurd. The result is that for many, many people illness in the family tends to be neglected. I do not believe there is a Deputy in this House who does not know of a case where perhaps the breadwinner, the father, knows that he should see a doctor, that one of his children should see a doctor, or that his wife is in need of medical care. He is carrying on on his wage—even if it is a large wage it is still a limited wage—and he is deterred from calling in the doctor, not so much because of the doctor's fee as by the fact that the doctor will write a prescription, which must be brought to the nearest chemist, directing the provision of some highly expensive drug or medicine. More often than not, because of that, people unfortunately put off calling in the doctor. They hope the illness will disappear, that everything will be all right in the morning, and neglect of illness frequently takes place.
The result is a very high hospitalisation rate. Illness neglected leads inevitably to admission into hospital. The hospitalisation rate in this country is very high indeed. In relation to working days, it has been estimated that the labour pool in this country suffers a loss of 14,000,000 working days—that is equal to seven per cent. of the days worked by the total labour force— due to hospitalisation as a result of workers not getting the necessary medical attention. Such workers inevitably find themselves in hospital eventually. That is a gap, a very definite gap. That is clearly a grave defect in our present health services.
I should like to mention another defect. When a person who is supposed to benefit by the present health services, but who has no medical card, goes to hospital, it is then, and only then, that he is required to pay. If he or one of his dependants needs hospitalisation, it is then he must pay. When a man is ill and not earning because of illness, it is then under our present Health Act that charges fall upon him. Each such person in hospital who has no medical card is required to pay 10/- per day for his hospital treatment.
