Dáil Éireann díospóireacht -
Thursday, 3 Mar 1966

Vol. 221 No. 6

Committee on Finance. - Vote 48—Health (Resumed).

Debate resumed on the following motion:

That a sum not exceeding £17,337,000 be granted to defray the charge which will come in course of payment during the year ending on 31st day of March, 1967, 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. — (Minister for Health.)

Mr. Coughlan

To continue last night's discussion, I was about to draw to the Minister's attention the expense involved in the use of the helicopter mercy service. I also told him about the publicity that was given to it both by his Department and the Department of Defence. Mercy missions are all right, but are they mercy missions? My experience proves that the opposite is the case, that they are merciless missions. When I inquired as to the expense involved in the carrying of a critically ill patient by helicopter, I was told—so were the Limerick Health Authority—by the Department that the cost of the mercy mission service was £67 an hour from the time the plane leaves its stable in Casement Aerodrome until it flies back.

I see no mercy attached to such a mission and I should like to point out to the Minister—I wonder why he is not here this morning—that you can charter a plane from Shannon Airport to carry 20 or 30 people to Belfast for a much smaller sum. In reply to a question last week or the week before, the Minister stated it was purely a book arrangement, a book entry as between his Department and the Department of Defence. That was the impression he left not alone on the House but on the people of the country generally. I do not know what the Minister means by the term "book entry". I call it a book exit—an exit from the cheque book of the person involved. I see nothing but an exit and a brutal one at that—£67 per flying hour. Where is the mercy about that mission?

I throw my mind back to a couple of years ago when they were snowed out in County Wicklow and an unfortunate woman, a maternity case, was brought down a mountainside on a shutter.

Mr. P. Brennan

Five months before her time.

Mr. Coughlan

More luck to her, but it does not get us away from the fact that she was hauled down the mountainside on a shutter. Had the helicopter service been available, that unfortunate critically ill person would have been charged we do not know how much money. It would have been squeezed out of her.

Mr. P. Brennan

It cost her up to £80 because she had to stay in hospital four months.

Mr. Coughlan

More shame to the Wicklow County Council. More shame to the Department of Health.

Mr. P. Brennan

There was no necessity for it.

Mr. Coughlan

I am not a doctor. That was a matter for the Department of Health.

Mr. P. Brennan

The doctor gave instructions that the woman was to be brought down.

Mr. Coughlan

It does not matter who gave the instruction. Anyway, I am talking about the helicopter service and I shall try to relate it to an incident in my own constituency. Returning to Wicklow for a moment, if the helicopter had been in service for 24 hours transporting sheep as well as human beings, who would have paid? Would it have been Wicklow County Council, the farmers or the unfortunate woman? I want to show the iniquity of this system of charges.

An Leas-Cheann Comhairle

The charge made for the helicopter is a matter for the Minister for Defence. The Minister for Health has no responsibility as far as the charges mentioned by the Deputy are concerned.

Mr. Coughlan

With all due respect, when I put down the question to the Minister for Health recently asking about the charge for this helicopter service, he said the fixed charge by the Department of Defence was £67 per hour and that in exceptional circumstances, additional charges might be made.

An Leas-Cheann Comhairle

It is a matter for the Minister for Defence and I cannot allow the Deputy to pursue the matter any further with the Minister for Health. There is no point in doing so.

Mr. Coughlan

I shall relate it to a matter with which the Minister for Health is concerned. The bill sent out goes to the patient involved or to his executors. It also comes to the local health authority. Is there not a relationship with the Department of Health in that respect? I have had experience in my county of a patient being transferred by helicopter and through the Limerick Health Authority a bill for £233 was sent out.

An Leas-Cheann Comhairle

Not by the Minister for Health.

Mr. Coughlan

By Limerick Health Authority who are directly under that Minister's control. I wish to impress upon the Minister that we must get rid of this hypocrisy that is being carried on by the Minister since he took office—this camouflage, this misleading of the people about the mercy service. What the Minister is saying in words he is denying in actions. I am sorry he is not here; I suppose he has a good reason for being absent. This thing has got to be stopped if we are to be honest, if we wish to get the job done. We in the Labour Party have gone to extremes to see that the people get a good health service, and we are right behind anything the Minister may do to improve the services. Before leaving the subject of the helicopter service, I should like to say that I intend raising it tomorrow morning at a meeting of the Limerick Health Authority.

Last night we dealt with the question of doctors and hospitals and with other matters referred to in this document of Mr. Aesop. We dealt with the ophthalmic services, with the treatment of the poor old people to whom I referred as discards. I instanced how ruthless some of the resident medical superintendents can be in the insistence on their rights vis-á-vis the secretary of the health authority and the county or city manager who is primarily responsible for the administration of the health services by the authority. One such superintendent—I have had experience of this—has questioned the right, the presence of our city manager in an institution in which the superintendent is alleged to be superintending. When our city manager, while investigating a complaint made by me, went to the hospital, his presence there was questioned by the resident medical superintendent. I pointed out last night that on many occasions patients requested me to go there and see them, but when I went there, at reasonable times, I was refused admission by that superintendent. I was told I had no right other than the right to call during normal visiting hours laid down for the ordinary general public. I applied to the Minister for Health to have the matter rectified and brought into line with the regulations in regard to mental hospitals, where members of the board are entitled to call at reasonable times. That was turned down by the Department within the past five or six months.

We have the Minister now coming along taking upon himself the right to pack these committees—I shall deal with this later—and I am sure the Minister for Health, being honest, knows nothing at all about packing or gerrymandering. I know that well. He is a very innocent boy, God bless him. I said it last night and I shall say it again tomorrow night if I am alive. However, is it not a sad state of affairs that we, who have stood trial before the verdict of the people, have not got the right to cry halt to some screwball who is in a job he is not fitted for and to which he is not entitled?

An Leas-Cheann Comhairle

The Deputy should not attack officials. The Minister for Health is responsible for the administration of his Department and any criticism should be directed at him, not at individual officials.

Mr. Coughlan

I want to bring this matter to the notice of the Minister so that he can act on it. I want him to realise what can happen when too much power is given to an individual. Any philosopher will tell him that it is not everyone who can wear authority. Some people with authority do not know whether it is turned inside or outside across their shoulders. They cannot wear it. They try to impress on everyone the great people they are. We, the elected representatives of the people, have to work in the interests of the people and we should not be hampered by such people.

I come now to another unfortunate section of the community who have received little or no consideration in the White Paper, the mentally handicapped children. In my part of the country, we long knew of the "cupboard child." It was like consumption long ago; everybody ran away from it. Thank God, Noel Browne surfaced it and made it like an ordinary cold in the head. But we still have the "cupboard child"—the child thrown into the cupboard when the neighbours or visitors come into the house. There is no provision for such children in this much publicised White Paper, Were it not for the charity, hard work and devotion of the religious orders, I do not know where we would be. I have experience in my constituency of their hospitals and schools and the work they are doing to try to provide some place in life for these unfortunate children.

It is a downright shame for the Minister that he has not provided a large sum for the education and training of these children. The Minister may be excused for not knowing the price of the helicopter but he has no excuse so far as this is concerned. Every year the Minister and I organise certain charitable functions, football matches, dances, flag days and so on in the city of Limerick. He organises a team and I organise a team to play each other in a friendly match. Every year we get about £500 or £600 from this. We started these functions because we saw how neglected such children were in Limerick.

Our first action when we got a few quid together was to start a school for mentally retarded children. I went to His Lordship, the Bishop of Limerick, and he gave me his wholehearted support. He sent two Sisters of Charity for special training, and they are now teaching those children in the school in Limerick. But we were faced with the problem of transporting these children to the school. It was because of that we started these charitable functions. We now have a minibus on the road. It collects the children every morning from door to door, brings them to the school and back home again in the afternoon. In this Christian country of ours today, is it not a sad reflection that we have to go cap in hand begging charity to try to do something which is the responsibility of the Department of Health?

Parliamentary Secretary to the Minister for Local Government (Mr. P. Brennan)

Did the Minister not indisibilit cate on page 44 of the White Paper that he is doing something?

Mr. Coughlan

I shall come to that in a minute. We also have the problem of X-rays. In the Limerick Health Authority, we cannot cope with the demand for X-rays we have every day of the week. A person is sent for an X-ray. It may or may not be a simple thing, but that person is out of work. He may have to wait three, four or five weeks before he gets to the X-ray because the queue is so long. He has to resort to social welfare benefit, workmen's compensation or maybe home assistance. Nothing is being done about this problem. We have complaints about it every day at meetings of the health authority but yet nothing is done. I would impress on the Minister the necessity for, not an overdose, but a good healthy dose of these pep pills he talks about in the White Paper. Instead of condemning pep pills, he should recommend them for himself and his Department to put a bit of life in them and get something done.

On the question of children's allowances, the Minister has doubled these but, again, we say that is not enough. With regard to the increased maternity benefits, I can tell the House that it was a hard battle to get an increase in maternity benefit for the quads in Limerick. It took six months of ballyragging the Minister every day and it was only in deference to public opinion that he gave the increase in the end. The Minister proposes to increase maternity benefit 100 per cent. I am rather wondering about another Minister who gives £15 for a calf. But the Department of Health gives only £8 for the birth of a child. I do not know which is regarded as the more important, the calf or the child. It is £15 in one case and only £8 in the other. Nevertheless, £8 is a big jump from £4 and a bigger jump still from £1, which was all it was for the quads in Limerick, £1 per head. This is some improvement, but it does not go far enough.

I should like now to do a little parsing and analysis on Mr. Aesop. As I said last night, this is a stolen document; nearly everything in it has been stolen from the Labour Party.

Mr. P. Brennan

I thought it was Fine Gael.

Mr. Mullen

Ours was years before that. Did the Parliamentary Secretary not read it?

Mr. Clinton

We wrote it.

Mr. Coughlan

This is a Labour document in miniature. I want to go back now to the days when we were in the back bench of the Leaving Cert. class. It is a big change from that to the front bench of the House of Parliament. At page 23, paragraph 27, the Minister states:

It will become increasingly necessary to ensure that doctors in general practice have opportunities for post-graduate study to keep themselves familiar with developments in medicine.

The Minister does not tell us what facilities he will make available to the GP to enable him to do a post-graduate course. How will it be done? I think we will have to prescribe a fine dose of sleeping pills for ourselves, as well as pep pills, so that we may start dreaming. This is nothing but a dream, the most of it. The part stolen from the Labour Party we want to see implemented as quickly as possible, but I fear it will not happen in our time.

In paragraph 31, the Minister says:

A recent projection of the population, prepared by the Central Statistics Office, taking into account the natural increase (that is the excess of births over deaths) and allowing for a reduction in emigration with economic development, suggests that the population by 1976 may be as high as 3,152,000 and that by 1981 it may be almost 3,400,000.

More sleeping pills: more of the dreams. Where did the Minister get that figure? What does he think we are? I want the Minister to answer these questions when he comes to reply.

In paragraph 32, we find:

Secondly, the changing balance as between the rural and the urban population will affect the organisation of the services and, in some degree, the diseases which they will be designed to combat. In 1960, 37.0 per cent of our workers were employed in agriculture, forestry and fishing. By 1970, it is expected that this proportion will have dropped to 28.7 per cent.

What a reflection! We want to see rural Ireland preserved, maintained and populated, and here is the Minister telling the truth for once: the flight from the land is on and he is preparing for it; he hopes and prays it will continue with even greater speed than in the past.

Paragraph 44 deals with proposals for new service.

The details of this service will be discussed with the medical profession...

I repeat what I said last night; the word "discussion" and the phrase "will be discussed" appear on every page of this White Paper. "Discussions will take place: This will be discussed." I am sure every Deputy was circularised by the Medical Association with regard to payment and it is our understanding that there is disagreement already in that matter. However, discussions will take place. I am dizzy from the repetition of the phrase in this document.

... before any final decisions are taken, but it is possible at this stage to indicate that the Government have in mind that the service will be such that an eligible person will have the right to be attended by any doctor participating in the scheme who is living within a reasonable distance...

What is a reasonable distance? That has to be defined.

... who is willing to take him as a patient and who has not already a full list of patients...

Where do we put up the "House full" sign? I want the Minister to tell us that when he is replying. I want to know what this means. I know what the document is all about. I know why it was introduced. I will take the song and dance out of it now once and for all.

In the same paragraph, on page 32, we find:

but that there would probably have to be some restriction on entry into the service by other doctors, to avoid too many doctors participating in any area and each not having a worthwhile panel...

Who is advocating restrictions here and who will administer the restrictions? Who is going to find out whether the panel is worthwhile or not? Some doctors are available the whole round of the clock and some engage in activities like shooting, fishing, golf, and so on. Who will plan the panel?

Paragraph 45 on the same page reads:

... The dispensaries would not be retained by the health boards for the provision of general medical services. Where the premises were suitable and were not needed for other health services, it might sometimes be possible to rent or sell them to doctors for adaptation as general surgeries.

To me that means that the doctor can buy the old dispensary or what remains of it from the health authority. If it is not in good condition, he can put it into a condition where people can visit him. Then he will divide the "haves" from the "have-nots". The men and women with the medical cards, the "have-nots" will go down to the old dispensary, but the "haves" will go up to his parlour and sit down and read Time or whatever is put before them in the waiting room. The rats can continue to run around the dispensary as they are doing at present. I want to see that sort of thing stopped.

Mr. P. Brennan

This is the Labour Party's document.

Mr. Coughlan

A miniature of our document.

Dr. O'Connell

Some of it.

Mr. Coughlan

There is one difference. If we had our imprimatur on this document, we would implement it.

Mr. P. Brennan

When?

Mr. Coughlan

Immediately. Fianna Fáil have no intention of doing it.

Dr. O'Connell

We will swop places and see.

Mr. P. Brennan

It might be better to let the people decide that.

Mr. Coughlan

That will not be for a long time. Fianna Fáil are funking the local elections, as it is. Do not draw me into that arena. Paragraph 48, page 33, deals with the supply of drugs, medicines and appliances under the new service. The last sentence of it reads:

It is, therefore, hoped to negotiate a satisfactory and economical scheme with representatives of the retail pharmaceutical chemists under which prescriptions given by doctors to patients under the service would be dispensed by retail chemists from stocks supplied by the health authority.

Apparently the health authority will buy a delivery van and go round to the chemist shops in Limerick and throw in boxes of medicines and tell the chemist to fill his shelves with them. A chemist is a highly qualified man. He has to do a very difficult course in chemistry and science and the examinations are extremely stiff. The majority of candidates fail their final examination when doing it for the first time. That is an indication of the severity of the examination for pharmacists. The Minister has taken it upon himself to turn this highly proficient man into a messenger boy and a parcel wrapper. There will be no longer any compounding to be done. All his years of education and of swotting at night time when every-body else is asleep will go for nothing. I do not think that is fair. All he will have to do is read the doctor's prescription and hand out the medicine over the counter. I should like to hear more from the Minister about the supply of drugs when he is replying.

It is very easy to be critical. There are many good things in this White Paper. Being a Labour document, it was bound to be so. The Minister has stolen our document and rehashed it. He has no intention of implementing it.

We agree with what is proposed in paragraph 51, page 34. At present in the issue of medical cards, the income of the house, the rent and overtime are taken into account. The application for the medical card is sent to one employer, then to the second employer, and to the third employer. From there, it is sent to the labour exchange and to the home assistance officer. It is time for a change in that system. We agree with the proposal that only the means of the person concerned and his or her spouse would be taken into account.

We agree completely with paragraph 57 on page 36, dealing with the general nursing. We come then to paragraph 59, page 37, where treatment in hospital is needed for defects discovered in school health examinations in national schools. This treatment is provided irrespective of the parents' means. I am glad the Minister for Education is here. Why not apply this to all primary, secondary and vocational schools? You cannot go half the road; you must go the whole way. As you have made your bed, you must lie on it. We maintain that this school examination should apply generally to all schools, primary, secondary, technical and vocational.

Mr. T.J. Fitzpatrick

(Cavan): And comprehensive schools.

Mr. Coughlan

One man or two men. However, we will leave the poor Minister alone. He has enough on his plate and we will let charity prevail at this stage. We will give him our moral support as far as it will take him. I want to say, on behalf of my Party, that we are concerned that this matter should be one for national schools only. Why not apply it to all children? As far as we are concerned, they are all equal and are all entitled to the same benefits. They can demand the same benefits and why not let them have them? I cannot see, for the life of me, why our medical officers cannot enter the private schools or secondary schools and carry out an examination just as detailed as they do in the national schools. I am putting that before the Minister for his consideration.

I want to move on a bit. I have already dealt with the helicopter service, and I want to move on now to page 45, paragraph 81. That brings me back again to the discards, those poor unfortunates who have been thrown on the dung-heap of life. The Minister comes along here and gives a figure based on the year 1961. Why 1961? Why did he not come closer home? Is it because the figure for 1961 suits his palate and would be much more palatable to his Party and the people? Is he being untruthful with us? I am sure that is the last thought in the Minister's head, knowing him as I do. It is not within his power. I want to know why he did not give us a later figure if it was available. I do not know whether it is or not. He gave us, on the preceding page, page 44, the same figure here for the years 1936, 1946, 1951 and 1961. Why not bring it up to date and I am sure we would have a more vivid and certainly a more unpleasant picture of the situation with regard to our discards, the old people.

We agree in full with paragraph 83 on page 46 in connection with home nursing. This is a good idea. As I said last night, thanks be to God, we have reached a stage in the country today where girls of Leaving Certificate honours standard are clamouring for the nursing profession. They cannot be facilitated. I am glad the Minister has now set about making some provision for those people and at the same time, is giving us this home nursing, as I will call it, which is badly needed. This will save our hospitals a whole lot of trouble and make beds available for more urgent cases. We are in whole-hearted agreement with that. I have already dealt with the maternity cash grants and compared them with the heifer scheme of the Minister for Agriculture.

Mr. Carty

Good man yourself.

Mr. Coughlan

I want to repeat for the benefit of the intruders that I have pointed out——

An Leas-Cheann Comhairle

There is no need to repeat. It is not in order to do so.

Mr. Coughlan

I just want to say that Mr. Haughey, if he were Minister for Health, might make the maternity benefit £15 because he has already given a substantial heifer grant and he might give an equal cash maternity grant, which the Minister for Health is giving.

Mr. Carty

A bob a gallon.

Mr. Coughlan

You will not throw me off. I already discussed, last night, the dental service. Indeed the Minister for Health got front page news this morning in one of our national papers with regard to the statement he made concerning the services as supplied in Limerick city. I am sure, at our health meeting tomorrow, he will be taken to task on that, as he has already been taken to task by the manager and the secretary of our health authority when he made an outrageous accusation with regard to an overdraft we were carrying of £300,000. He accused us of ineptitude, as he did the Dublin Health Authority, last week. He accused us of not being up to date and of being backward in arranging our accounts and our estimates.

The matter was thrashed out at our last health authority meeting but there has been no reply from the Minister since. That is only one of the times he has had to sit back in his box as far as Limerick is concerned. It happened again at a Tuairim meeting the other night with regard to this. With the help of God, we will have a treble after tomorrow's meeting of the health authority in Limerick with regard to the dental services which he said to me last night were the worst in Ireland. That will be proved tomorrow. I do not accept it at this stage.

I now come to the final few paragraphs in this document on which I expect a clear-cut and honest reply from the Minister. He says, on page 61, paragraph 121, that having regard to the general economic conditions, he is going to see what public expenditure in hospital buildings can be carried out. We are anxiously awaiting that.

I come now to the most important paragraph of the whole document. On page 64, paragraph 126 says:

Notwithstanding the strong case for changing the administration of the health services in this way the Government would not wish the change to be made if there were a danger that the transfer from them of their health functions would so diminish the scope of the local authorities' work that they would become ineffectual bodies evoking little interest in the community. This danger is not real. If the existing local authorities lose the direct administration of the health services, which now makes up about one-third of their total activities, they will still remain beneath the Government itself, probably the most important administrative organs in the State. Shorn of their health functions, the county councils would but be restored, as respects the scope of their work, to what they were in the nineteen-thirties, as health services of our present-day scope are quite a recent addition to their functions.

Listen then to this amusing statement:

The local councils will retain responsibility for the general planning and development of their areas, for the improvement and maintenance of the roads system, for housing development, for sanitary services and for several other general local governments functions.

Progress reported; Committee to sit again.