I move:
That a sum not exceeding £10,387,100 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, 1965, 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 a Grant-in-Aid.
The Estimate for Health for 1963-64 was debated in this House as recently as late February last. On this occasion, therefore, I intend to be brief. I have, however, circulated to Deputies the statistical information which I should have given to the House orally.
The figures for births, marriages and deaths for the last five years indicate that, in comparison with 1962, deaths in 1963 were fewer by 0.8 per cent, marriages were fewer by 2.1 per cent but births were greater by 1.9 per cent.
While the number of deaths from all forms of cancer was up slightly in 1963, the number of deaths from lung cancer was slightly lower than in 1962. The number of Cobalt Units available for treatment of the disease is to be increased to three; a second unit being installed at St. Luke's Hospital, Dublin, and a separate unit at the special Cancer Clinic, Cork. All these units will be available to referred patients from all over the country. In this regard special arrangements exist between St. Luke's Hospital and the two other Dublin hospitals which specialise in the treatment of cancer.
As an element in our cancer diagnostic service, provision is being made for the early diagnosis of pre-cancer conditions of the cervix. For reasons of economy and convenience the facilities will be concentrated initially in a single laboratory at St. Kevin's Hospital, Dublin. The service will become available when the Dublin Health Authority have recruited a cytologist.
To publicise the association between cigarette smoking and lung cancer the following steps have been taken: the summarised findings of the United States Advisory Committee and other authoritative investigations are being distributed to teachers, clergymen and others; posters are being prepared for display in public places; and the appropriate franking of letters is being arranged. The reverend editor of Our Boys and An Gael Óg has very kindly offered free advertising space to persuade the wide readership of these magazines never to smoke. Finally, the tobacco companies and advertising interests, including Radio Éireann, have been asked to meet my Department to discuss the formulation of a general code to regulate the advertising of tobacco.
Though there has been a considerable decline in it, and in infant mortality, the maternal mortality rate here continues to be higher than in the neighbouring island. It is recognised that there are special reasons for this, most noteworthy the later age of marriage among us, our larger families and the rarity of therapeutic abortion.
The death of a mother in childbirth has such tragic consequences for the family that, wherever possible, its cause should be ascertained and studied. With this end in view the Irish Medical Association have agreed to set up a special Committee to consider, as far as possible, the circumstances of every maternal death; but not, I would emphasise, with any other objective than to discover the cause and to search for a remedy. I would like publicly to thank the Irish Medical Association for their co-operation in this important and difficult matter.
It is relevant that I should mention that a revised form of the contract to be entered into between health authorities and doctors participating in the maternity and infant scheme, has been negotiated recently with the Irish Medical Association.
The decline in the need for beds for the treatment of tuberculosis, and in the number of new cases emerging, gives some cause for gratification, but none for complacency. It can be said with truth that the disease is under control. Yet elimination, and not just control, must continue to be our aim. We still have throughout the country, I am sorry to say, an undiscovered pool of infectors, estimated by some authorities at as many as 7,000, a very large part of them males of middle-age. Men in the upper age groups have a particular responsibility to the community and to themselves in this matter; for it has been established that, of the new cases of TB currently being discovered in males, no less than 45 per cent are 45 years or older. The community has provided an excellent mass-radiography service for the detection of tuberculosis. Recourse to it has already saved very many lives. In their own interest all persons over the age of 12 years should avail themselves of the facility, should, indeed, come forward for X-ray every time one of the mobile units is in their district. If we were given this modest degree of co-operation by the public, I have no doubt that in a relatively few years the disease would have virtually disappeared from our midst.
The Commission on Mental Illness which I set up in July 1961, continues to apply itself diligently to its comprehensive and difficult task. It has made considerable progress and may be in a position to report towards the close of 1965.
The Commission has been anxious to ascertain whether in our circumstances psychiatric units, attached to general hospitals, would yield the good results which have been obtained elsewhere. I put the suggestion to the Waterford Health Authority and it has agreed to establish such a unit at Ardkeen Hospital. Currently the Galway County Council has under consideration the provision of another such unit in the Galway Regional Hospital. I hope that by the end of the year these units will be in operation.
A new mental hospital is being established at Newcastle in County Wicklow. It should be ready to receive patients within a few months; and, while reducing overcrowding in the Dublin mental hospitals, will provide a much improved psychiatric service for the people of County Wicklow. This new development has been made possible by the co-operation which was extended to me by the former Board of Governors of Newcastle Hospital, the Wicklow County Council and the Dublin Health Authority, and for it I thank them most warmly.
I have made certain suggestions to the respective health authorities for Cork and Kerry for the improvement of their psychiatric services. The services currently provided by them are, I regret to say, among the poorest in the country. It must be said, however, that for this, no blame attaches to the present psychiatric staffs.
Time does not permit me to analyse the reasons why the patient population in our mental hospitals is so very much higher than elsewhere; but I must suggest the main reason for its decline in recent years. In my opinion, it will be apparent from the table, which relates this downward trend in hospital population to the upward trend of attendances at out-patient clinics. The figures demonstrate how effectively good out-patient services obviate the need for in-patient treatment, to the great advantage of the patient, his relatives, his employer and the community generally.
Residential accommodation for the mentally-handicapped increased by 156 places to 2,897 in the period April to December, 1963, and there have been further developments since then.
The Galway County Council is considering a request by me to transfer the former orthopaedic hospital at Woodlands to the Brothers of Charity. If this is acceded to, I shall make a grant from the Hospitals Trust Fund to enable the premises to be adapted for some 110 mentally-handicapped patients, later it may be possible to raise this to 150. The Order have also agreed to provide 60 places in one of their institutions at Waterford.
The Home run by the Sisters of Charity of St. Vincent de Paul at Lisnagry, near Limerick, is being enlarged to take 60 more children. Works in progress or about to commence at Stewart's Hospital will increase the number of places there by 50. By autumn an additional 60 places will be available at Delvin, County Westmeath; and I understand that in the next few months the Cork Polio Association will be in a position to receive a further 50 children. Places for 30 more trained mentally handicapped persons from existing institutions, who cannot yet return to their homes, have been made available in Peamount Hospital since December. Excluding the possible further addition at Woodlands, this additional accommodation will represent 420 new places, an increase of almost 14½ per cent on accommodation available in December last. It is hoped that all of it will become available within the next 12 months. The Commission of Inquiry on Mental Handicap is still meeting regularly and will, I hope, be in a position to report by April of next year.
In 1957 the deficits of voluntary hospitals amounted to about £960,000. By 1960 they had risen to £1,440,000 and in 1962 were £2,160,000. That is to say they had more than doubled in five years, to the point, indeed, where almost three-quarters of the annual revenue of the Hospitals Trust Fund was being swallowed up in the payment of deficits. Such a situation, the House will agree, could not be allowed to continue, for the primary function of the Hospitals Trust Fund is to finance the building, improvement and equipment of hospitals, and it has developed because of the failure of the capitation rates payable by health authorities for their patients in the voluntary hospitals to keep pace with the rising costs of their maintenance and treatment in such institutions.
As a first step towards redressing this situation, the capitation rates were increased with effect from 1st October, 1963, and this secured a net reduction of approximately £140,000 in the estimated deficits for the year ended 31st December, 1963. When, however, the preliminary estimates, supplied by the voluntary hospitals for the year 1964, were studied it was found that the deficit would be £2.1 millions, and that a more drastic approach was essential. On the other hand, if the balance were to be redressed solely by increases in capitation rates, the burden on local authorities would be extremely heavy. To relieve the situation, the Minister for Finance agreed to make a grant-in-aid of £1 million to the Fund for hospital building, so that it became possible to limit to £350,000 the additional net contribution required from health authorities. This sum of £350,000 is, of course, supplemented by a similar sum, payable by way of health grant, provided for in Subhead G.
After the new capitation rates had been settled, the ninth round of salary and wage increases was agreed upon, and it is estimated that this will cost the voluntary hospitals £350,000 for a full year. Thus one half of the yield from the latest increase in the capitation rates will be absorbed under the single heading of increase in the remuneration of staffs.
The daily rate at which health authorities are now paying for services provided in general teaching hospitals is £2 3s. 6d. This sum covers all services, including those of the visiting specialists, the only additional or special charges being in respect of a limited range of items such as exceptionally costly drugs, and radiation treatment in cancer hospitals. The average cost of treating and maintaining a patient varies from hospital to hospital, but in the case of the ten Dublin general teaching hospitals it is estimated now to lie between £2 16s. and £4 16s. a day. As with the teaching hospitals, so also with the nonteaching hospitals. In their case, the present daily rate of payment per health authority patient is £1 12s. but the estimated average cost of maintaining and treating each such patient ranges from £1 16s. to £2 17s. 6d., with the majority above £2 8s.
With the grant-in-aid from the Minister for Finance of £1 million, I have been able to continue with the hospital building programme; so that the value of building work in progress on the voluntary hospitals or to be in progress by the end of the year will be about £5 million. On the local authority side, the value of work in progress on 31st March last was £1.1 million and the value of the additional work which will be in progress by the end of the year is £1.55 million. The totals of these items for works in progress on 31st March last is £5.3 million and for additional works which will be in progress by the end of the year is £2.35 million. Some major works in progress and which will have gone to tender before the end of the current financial year are listed in the statement circulated.
The works now in course on county homes and others for which tenders are expected during this year are set out in the statement circulated. Their total value is estimated at £2.8 million. These works are not financed from the Hospitals Trust Fund but from loans granted from the Local Loans Fund, the State subvention being paid by way of 50 per cent subsidy to loan charges.
The cost of drugs and medicines in the health services continues to increase and gives rise to anxiety. Where, however, the use of an expensive drug results in the speedier recovery of the patient, the immediate additional cost involved may be justified not only on compassionate grounds but on financial grounds also. Not only may the patient be spared a spell in hospital, or may have to spend less time there, thus reducing maintenance costs, but he may be able to resume work earlier, with benefit to the economy as a whole.
The existing system of purchase by local authorities ensures that what is bought is bought economically. It is to the system of user, therefore, that we must look for any possible economy. Accordingly, following preliminary informal discussions between officers of my Department and representatives of the Irish Medical Association, a small working party, consisting of representatives of the central and local health authorities and the Association, was set up to examine the situation and to make recommendations. I am again indebted to the Irish Medical Association for their willing co-operation in this matter.
I am glad to be able to inform the House that, coincident with the increases in Social Welfare non-contributory allowances announced by the Minister for Finance in introducing his Budget of this year, the rates of Infectious Diseases (Maintenance) Allowances will be correspondingly increased. When I spoke in the House on 5th February last in regard to the rates of Disabled Persons Allowances, I expressed the intention to bring them into closer relationship with the rates of non-contributory old age pensions when circumstances permitted. As a step in that direction, the maximum rate will be increased by 5/- a week with effect from 1st August next. The new rate will be 32/6d. weekly.
Thalidomide was first introduced here in May, 1959, and was withdrawn from sale in January, 1962. The effects of consumption of the drug would, therefore, be reflected in births occuring from late autumn of 1959 to the late summer of 1962. I shall refer to this as the thalidomide period.
In 1962 the Medical Research Council, at my request, undertook a survey to ascertain, so far as was practicable, the number of babies born with deformities which might be ascribed to the use of thalidomide by expectant mothers. I should stress here that deformities resulting from thalidomide are of a particular pattern; but not all deformities of this pattern can be ascribed to the use of thalidomide. Thus in the course of the survey an investigation of the records of over 37,000 births which took place in 1953-54, long before thalidomide came into use, revealed 12 cases of defects of the thalidomide type, giving an incidence of 0.32 per thousand births. In the year 1961-62, which was the year of maximum thalidomide effect, the survey disclosed that the incidence was 1.20.
It also revealed that a total of 67 surviving babies were born with these defects in the entire thalidomide period, and of these, applying the incidence factor I have mentioned, about 53 might have been affected by thalidomide. The current survey being conducted by the Medical Research Council, covering births in the postthalidomide period, will show us whether the current incident figure of thalidomide type defects is greater or less than the 1953/54 figure to which I have referred and will enable us to say with greater accuracy the extent to which thalidomide was responsible for these defects in children born in the thalidomide period. The results of the new survey should be available later this year.
While it is important that we should have this data, what is of far greater importance is what we can do for all these children born with limb defects, whether or not the defects are due to thalidomide. This is a task which I have assigned to the National Organisation for Rehabilitation. They have investigated very thoroughly the facilities which have been developed abroad and, as a result, are in a position to offer a highly specialised service, including artificial limbs of a special type and other devices, which will go a considerable distance towards minimising the disabilities of these children and will enable them to develop and lead reasonable lives.
Surveys have indicated that we have suffered no perceptible harm from nuclear weapon testing and, in the absence of renewed large-scale tests, are not likely to suffer any.
Much concern has been expressed at the possibility that the district services associated with the Queen's Institute may be discontinued, and in that connection I would repeat that I should be extremely sorry to see these services suspended or curtailed. I have always dealt sympathetically, as my predecessors have, with such representations as were made to me by the Institute and have undertaken to meet their representatives. It has been due solely to the fact that the Council of the Institute have been awaiting the views of the branches before they came to see me, that such a meeting has not yet taken place.
Before I conclude, I should like to mention a matter which may be of particular importance in relation to the state of our children's teeth. In April, 1962, I requested a number of persons to become members of a Committee to recommend to me the best procedure to be adopted to measure the effectiveness of (a) fluoridated water and (b) the topical application of fluoride in conjunction with fluoridated water, to plan and direct the required survey work for these purposes and to precisely evaluate what will be the results in due course.
This Committee has seven members, four of whom are University or Dental Hospital personnel, the remaining three being from the Department of Health and the Central Statistics Office. A number of meetings have been held by that Committee and they have obtained expert advice from Dr. Baeker Dirks of the University of Utrecht. In February, 1963, they recommended the type of survey which should be carried out to measure the effectiveness of fluoridated water and the topical application of fluoride and also the staff that would be required for this purpose. It is envisaged that the director of the survey should be selected by the authorities of University College, Cork, who have agreed to co-operate in the survey work in consultation with the expert committee. I have approved the programme and finance sanction has been obtained for it. The item of £6,000 which appears under subhead G is for the purpose of carrying out the survey.
This short review has been necessarily sketchy. If time permits, I may be able to elaborate in my reply to the debate on particular points which are of special interest to Deputies. I feel, however, that we can justifiably claim that the quality of the health services available for our people is, on the whole, excellent and keeps pace with modern developments. Where we are behind as, for instance, in our psychiatric services in certain areas, we are rapidly catching up. I recommend the Resolution to the House.
