Dáil Éireann díospóireacht -
Tuesday, 27 Mar 1962

Vol. 194 No. 4

Committee on Finance. - Vote 54—Health.

Minister for Health (Mr. MacEntee)

I move:

That a supplementary sum not exceeding £565,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1962, for the Salaries and Expenses of the Office of the Minister for Health (including Oifig an ArdChláraitheora), and certain Services administered by that Office, including Grants to Local Authorities and miscellaneous Grants.

Almost wholly the need for this supplementary provision arises from the operation of the eighth round of increases in salaries and wages. Certain increases of costs have arisen for other reasons, as I shall explain, but these are a very small part of the Supplementary Estimate and they could have been met out of savings on the Vote generally.

The provision under Subhead A., covering Salaries, Wages and Allowances, is in respect of the staffs of my Department, administrative and professional. It is estimated that within the current financial year, the application of the remuneration increases to these staffs, in accordance with the increases awarded to the Civil Service generally, will cost £12,300, but against this, can be set a sum of £5,800 which will be saved as a result of vacancies in posts for which provision was made in the original Estimate. The net requirements are thus £6,500.

Under Subhead B. covering Travelling and Incidental Expenses, it is found necessary to seek an additional sum of £1,000. This is a variation such as may arise in any year due to an unforeseen increase in activity, involving more travel by officers of the Department, principally professional officers carrying out inspections.

Under Subhead G. covering Grants to Health Authorities, it is necessary to make additional provision to meet the increase in grants which follows on the increase of expenditure by health authorities in respect of remuneration of their staffs. The original provision under this Subhead proved to be very close to what would have been payable had not the "8th round" had its effect on the expenditure of the local authorities. It is estimated that increases in remuneration of local staffs will cost a total of £1,200,000. The grant payable in support of local expenditure is at the rate of 50 per cent., which means an additional sum of £600,000, but as five per cent, of the grant is withheld until final statements of expenditure have been submitted after the close of the financial year, the amount which will fall to be issued within the year ending on 31st of this month is estimated at £570,000.

The high proportion of the expenditure of health authorities which is absorbed by the remuneration of their staffs will be evident from the increase which must be faced as a result of the grant of higher salaries and wages. The total local authority expenditure of £18,130,000 on which the requirements under this subhead were originally based included £8,800,000 in respect of salaries and wages of their own staffs. The estimated addition of £1,200,000 brings this figure to £10,000,000. More than 55 per cent of the expenditure in the year 1961-62 on the health services is thus attributable to the remuneration of staffs of health authorities.

The additional funds sought under the subhead covering the supply of vaccine lymph are required to meet exceptional demands which arose following outbreaks of smallpox in Great Britain. In all, additional supplies sufficient to vaccinate more than 200,000 people were purchased from abroad, and these, together with a relatively small additional item in respect of storage, account for the full amount of the supplementary provision.

The items which I have mentioned comprise the total estimated additional expenditure and they amount to £581,900. Against this amount, it has been found possible to offset a total of £16,900 made up of £4,100 on anticipated increases in receipts under the heading of Appropriations-in-Aid, and £12,800 savings on other Subheads. These off-setting items represent relatively small variations from the original Estimates, and are such as would be expected to occur in the normal operation of a Vote of more than £9,000,000. The net amount of the Supplementary Estimate is accordingly £565,000.

Mr. T.F. O'Higgins

It is unusual to find a Supplementary Estimate necessary for the Department of Health and certainly it has not been common practice in recent years to introduce such an Estimate. The Minister has said that this Supplementary Estimate is necessary because of the eighth round of wage increases and we are faced now by the necessity to find an increase of some six per cent. in the money sought at the beginning of the financial year for the provision of health services. It seems difficult to understand why the effect of the eighth round was not contemplated when the original Estimate was brought before the House at the beginning of the financial year. Apparently it was not taken into consideration and now we must accept this increase as necessary.

I should like to direct the attention of Dáil Éireann to certain facts which emerge from this Supplementary Estimate which is due chiefly to wage increases. It appears that of a total health expenditure of roughly £18 million, close on 50 per cent. is involved in salaries and wages. That underlines some of the criticism expressed in relation to the manner in which our health services are at the moment organised. That 50 per cent. of what we spend on health must be devoted to salaries and wages is certainly alarming. However, we cannot do anything about that at the moment and we can only look forward to a more sensible organisation of our health services in the future. As they are at present constituted, apparently the sum sought by the Minister is necessary and must be provided.

The Minister in moving this Supplementary Estimate has, of course, had regard to the effect of the eighth round on the money which he must provide by way of grant-in-aid to health authorities. At the moment he provides 50 per cent. although he pays only 45 per cent. in any one year. Earlier in the course of our proceedings, I questioned the Minister as to whether this year he might consider increasing the proportion of that grant-in-aid. He found himself unable to answer that question either affirmatively or negatively. He referred to the fact that a Select Committee of this House was considering health services and matters concerned with them.

I should like to give the Minister fair notice here and now that the existence of the Select Committee on the Health Services will not be recognised by anyone on these benches as an umbrella to protect him from dealing with the effects of the health policy which he and his Government colleagues are pursuing. It has resulted this year in an impact on rates all over the country. The increase which necessitated this Supplementary Estimate has also been felt by every health authority throughout the country.

An Leas-Cheann Comhairle

The Deputy will appreciate that the general policy of a Department is not in order on a Supplementary Estimate.

Mr. T.F. O'Higgins

I appreciate that but I am making only a passing reference to the fact that there must be, parallel with the increase for which this Supplementary Estimate is sought, a corresponding impact on the rates which certainly has meant a very substantially increased burden on every ratepayer. When this year the eighth round brought home to the Minister that we were devoting out of the money we voted for health services almost 50 per cent. for the payment of salaries and wages, I should have thought that would lead to new thinking on the manner in which our services were organised and that as a matter of urgency a new policy would be embarked upon. That is not to be. We are to have a Committee. A Committee is apparently to report and advise and until such time as that is done, the Minister will not be in a position to give the simplest answer to the simplest question.

I observe that portion of the sum sought here relates to the supply of vaccine lymph. I can understand that this sum is found necessary because of the increased demand made upon supplies by reason of the outbreak of smallpox in the neighbouring island of Great Britain. Fortunately, we have not had an outbreak of smallpox in this country since the early years of the 1920s and let us hope that no such outbreak will take place. By reason of the proximity of the smallpox outbreak, particularly in Wales, understandably, there has been—and very properly—an increased movement towards vaccination.

Perhaps the Minister may not be in a position to deal with this now. Possibly later on he may have some information but I should like to bring to his notice the fact that there has been a general feeling that whatever vaccine is used for these vaccinations has had a general weakening and definite reaction within ten days or so. It is commonly stated that the vaccine is either unduly strong or possibly may not be entirely suitable. If the Minister is in a position to deal with that now, I should be obliged if he would or, perhaps, if he finds it more convenient, he might devote portion of his speech on the main Estimate to that feeling which is abroad.

As I say, we cannot oppose this Supplementary Estimate. It is unfortunate that it should be found necessary. It indicates the march of increasing costs for our health service without any corresponding increase in the standard and value of the services.

Mr. Dillon

Grants to local authorities amount to £570,000. I think I am correct in saying that that represents approximately 45 per cent. of the total charge. That means that the local authorities have to find approximately £600,000 to match this grant. I wonder if the Minister might avail of the setting up of the Committee to use it as justification for a more liberal approach to this particular subhead instead of an umbrella to disclaim responsibility for the added burden the ratepayers have to bear. I do not think he will query the fact that the total sum of approximately £1,100,000 which has to be found by the local authorities under the Health Services (Financial Provisions) Act, 1947, is largely the result of the policy for which the Minister is responsible and which the Government are operating.

Without going into the merits of the policy, I wonder if the Minister has not sought to obtain a larger appropriation to relieve the rates position, bearing in mind the fact that the rates part of this sum has to be found by farmers, small and large, and by business people in country towns who are not benefiting by the large outlay of public funds and quasi-public funds which is taking place in building in our cities and larger urban centres. I often think this House has completely forgotten the circumstances of the ratepayers in the country towns. The farmers have made known their reaction by peaceful and emphatic demonstrations in the public streets to draw the attention of the public to the fact that, while their incomes remain static, or decline, their charges in the form of rates are steadily rising.

An Leas-Cheann Comhairle

I think this would be a matter for the main Estimate rather than for this Supplementary Estimate.

Mr. Dillon

I am making the case on this Supplementary Estimate that this subhead should be enlarged as an ad interim measure to lighten the burden, pending the completion of the review of the whole system; and I want to draw the attention of the Minister to one section of the community that I think he has completely forgotten. The circumstances of the small businessman in rural Ireland have been greatly exacerbated, first, by the decline in the income of the people whom he is trying to serve and, secondly, by the disappearance of 250,000 people from the country in the past five years. These 250,000 potential customers of the country shopkeeper have left this country in the past five years, with a corresponding reduction in the volume of business these people are able to transact. At the same time, the rates on the premises in which the business is being conducted are steadily rising.

An Leas-Cheann Comhairle

The Minister for Health has no responsibility for the rates.

Mr. Dillon

I do not want to press it, but, surely, if he made an ad interim appropriation of £1,000,000 from the Central Fund or the Supply Services to meet this charge, that would relieve the rates of £500,000?

An Leas-Cheann Comhairle

I must point out to the Deputy that this is a Supplementary Estimate and it is usual to confine the debate to the purpose for which the Supplementary Estimate is required. In dealing with the question of rates, I feel Deputy Dillon is going outside the ambit of the Supplementary Estimate.

Mr. Dillon

If that is your ruling, I shall leave the matter to germinate in the Minister's mind, as I hope it will, because, if it does not, the situation in rural Ireland will, in my opinion, become truly critical.

Deputy O'Higgins has mentioned vaccination lymph. Vaccination, as a consequence of the outbreak of smallpox in Great Britain and on the Continent, has naturally expanded here. It is only right that ample supplies of lymph should be made available. As Deputy O'Higgins said, it is true that the lymph being used, while it produces in no case anything approximating to lethal consequences, has had the result that some children and adults reacted to it much more distressingly than has been our experience in the past. It would be a great pity if the impression were spread abroad that, as a result of the precautionary measures at present being taken to vaccinate against smallpox, vaccination against smallpox is something more serious than it really is. The fact is that the disturbance in health on vaccination against smallpox is normally very slight indeed, while the consequences of contracting smallpox, without ever having been vaccinated, are truly appalling.

I can recall the grim picture painted for me by my father when he was a young medical student in this city during a smallpox outbreak in the nineteenth century. A young medical student who shared digs with him disappeared from the digs. My father went looking for him and ultimately discovered him dying in one of the smallpox wards of a city hospital. He succumbed largely because of the fact that he had never been vaccinated, whereas others who had been vaccinated, even in very early childhood, got the disease in a very mild form, and those who took the prudent precaution of repeating vaccination came unscathed through the epidemic.

Smallpox has become so rare that people are inclined to forget all the horrors that attend on the disease when the patient has never been vaccinated. It is a good thing to emphasise the gravity of that danger and, at the same time, to remove, in so far as it is within the Minister's power, any widespread impression arising from the use of the present lymph supply that there is any serious inconvenience in being properly vaccinated.

I do not know whether the Minister had time fully to explain to what exactly the deficiency in the recoupment from the American Grant Counterpart Fund in regard to technical assistance is due. Is it that the Counterpart Fund is exhausted and that part of the appropriation for health has simply got to fall on the Supply Services?

I do not know that there is any other matter to which I wish to refer but I should be glad if, in answering, the Minister would touch on the points to which I have referred.

Mr. P. Hogan

(South Tipperary): I merely wish to plead with the Minister to consider increasing the amount of the grant to local authorities. At present, it is on a 50/50 basis and it is becoming increasingly difficult for local authorities to meet the various subventions they are called upon to meet. A large part of the increases local authorities have to pay are due to policy initiated by the Minister and his Department. An example of that is the raising of the ceiling from £500 to £800 which means that an increasing number of people have now to be admitted to institutions at some nominal fee.

Sir Anthony Esmonde

I should like to draw the Minister's attention to the fact that some national policy is desirable in evolving effective measures to ensure that smallpox is not introduced into this country. I appreciate that the Minister and his officials are doing everything they possibly can in that respect. I appreciate the active measures taken. The Minister told me in reply to a question recently that he did not think it was possible to ensure that no smallpox would be introduced into this country from Wales. Wales is not very far from Rosslare Harbour. In the changing circumstances of our modern world, we are exposed to considerable risk. Numbers of visitors come in here now as compared with the not so distant past. There has not been a case of smallpox here for over 60 years. There was no threat until quite recently. It is well to appreciate that the threat is there of smallpox invasion into Europe and its subsequent entry into this country. It can be brought in here by Asian visitors.

Further consideration of Vote postponed.