I regret that I was three minutes late.
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.)
One minute late.
We will settle for a half-minute.
The Minister will have a good deal of settling to do before this year is over. I was dealing with paragraph 126 on page 64 of this document. The Minister in this paragraph pours forth his sympathy for the unfortunate, hardworking public representatives on the ground of the time, energy and ability they give to the working of local government generally. The Minister knows in his heart and soul that he is not being truthful. As public representatives, the more powers and responsibilities we have, the more we take from the officials and that is how we want it. and how the people generally want it.
The gem of this concoction is contained in paragraph 127 on page 65 under the heading "Proposals for Regional Administration." It states:
The Government accordingly proposed that legislation should be introduced to transfer administration of the health services from the existing local health authorities to special regional boards. The membership of these boards, it is envisage, would be made up of persons (including representatives of the medical and related profession and, where appropriate, of the voluntary hospitals) appointed by the Minister for Health and members elected by the county and county borough councils for their areas. They would thus represent a partnership between local government, central government and vocational organisations.
What a glorious dream! Knowing the innocence of the Minister as I do, having spent most of my life looking at him and listening to him and trying to decipher what he says today against what he will do tomorrow—the very opposite—I must condemn this. When I speak personally, I really mean that we in the Labour Party condemn this out of hand because this leads to only one thing: giving the Minister power to pack—which he is adept at, as he is adept at the gerrymandering that is going on today in the city of Limerick. It is power he will hold over the appointees, and I am sure they will not come from the Labour or Fine Gael membership in Limerick. On this body he will have the final say as to who will represent the people and who will implement proposals and see to the needs of the people in the administrative area.
We say this is wrong, unjust and unfair. It is the next thing to dictatorship. Are we to give any consideration to the voice of the people or the local authorities or even the National Authority? Does it mean anything any more so far as the Minister for Health is concerned in the light of this paragraph here? We shall go the whole way on this. We believe the people to run this authority are the people who represent somebody and we have no objection to representatives of the different professions, provided they have no vote on any matter of financial significance to the authority. We do not have to stretch our imagination too far to see, with the Minister's group in charge, where this whole administration could lead. Now is the time to stop it and we vehemently disagree with this paragraph.
I should like now to turn to paragraph 129 on page 65:
Some only of the local councillors would be included in the regional boards, but it is intended that there should be local advisory committees——
for what I do not know
——on which other councillors also might serve, to advise the regional board and its officers on the local operation of the services. In this way, the existing very live local interest in the development of the health services can be preserved.
Did anyone ever hear such nonsense?
Who is planning for the planner?
Now I turn to page 66, paragraph 130, to the sentence:
The members of the boards would have much the same powers of direction and control over their executive——
this is a gem
——as local elected members have over the manager, including control of the budget.
Will anyone tell me—and I have been a member of a local authority for 16 or 17 years—what control we have over the manager? None whatever. The only authority we have over the manager is to have the matter raised in the Press and through the Press, embarrass the manager as an administrator. That is the only power we have to bring the manager to book. We have to depend on that. If that does not cause him or his administration embarrassment, or perhaps cause embarrassment elsewhere, our power is nil. Here we have a repetition of the same thing.
As I said in the Minister's absence, there are people who can wear authority and people who cannot, and he knows it as well as I do, from the experiences we have had in our constituency of people who have been given authority. Every day we are moving more and more towards the dictatorial approach of the Government's Party with total disrespect for the public representatives. I have spoken at length on this document. Candidly, I think it is a fraud and that it will never be implemented.
I want to say in conclusion, now that the Minister is here, that everything comes home to roost if we take our time. As I said before, statements have been made on television, at dinners, at dances, at Tuairim symposia, and in all kinds of places, about this great document on the future development of our health services. I remember not so very long ago when the Minister returned to his native city as Minister for Health. Organised bands came out to meet him and there was a great hullabaloo and a great fanfare at the city boundary to welcome him to Limerick. That was very nice. Promises were made at the time that the entire health services were going to be torn from stem to stern. We were told that we were marching into the Garden of Eden, that there would be no more trouble, medical cards, hospital bills and helicopter bills were all going. It was a completely revolutionary approach and this is the result. If this is all that the Minister has to hand up to us, it is a pity he wasted so much time and a pity that there was so much money wasted on television, on Tuairim symposia and on all kinds of things all over the country welcoming this. I repeat what I said at the beginning, that it is only camouflage, creating a haze to blind the people to the present economic crisis through which the country is going.
Health and medicine is a subject that seems to be bedevilled. It is difficult to know why. Perhaps it is due to the fact that we are placed on this earth to suffer and to die and that subconsciously we feel utterly frustrated because no matter what steps we take to avoid those possibilities, they will still come. It means that no matter what system we devise it will not be successful. This subconscious frustration must have its outlet in some place and it has its outlet in attacking whatever schemes are proposed to improve our health and medical services. Everyone must have an interest in health legislation because at some time or other almost everybody becomes ill and suffers the consequence. There is no doubt that everybody must die and we look to medical care to provide for the prevention, cure and alleviation of our illnesses when they arrive and of whatever bodily defects we suffer. We also hope that medical care will prolong our lives and help up when we are dying.
Health legislation must have a few definite objectives and may have a few secondary ones. The primary objective of health legislation is the education of the whole community in the taking of preventive measures which are in their own interests and in the interests of the health of the community. It must also educate them in regard to what services are available and what they should do when they become ill. It must also provide services for people who cannot provide them for themselves. This objective is just as important as the first one I mentioned. To my mind, those are the two primary essentials in any health service.
Health services may have secondary objectives. Health services may be used as an economic or social weapon to help redistribute the wealth of the community and as such I suppose nobody will find fault with it, but as such it should not become a primary objective. Also, from time to time in other countries—it would never happen here—health legislation is used by political Parties to enhance their prestige and increase their power, but, as I said, that would not happen here so there is no need to deal with it further. Very few will disagree with me in the objectives I have outlined and the big problem of this House is to try to translate that into a practical system of medicine.
There is no doubt whatever that the best system of medicine is the one that enshrines the direct doctor-patient relationship. This is the system under which the doctor has the direct responsibility for his patient and under which the patient is absolutely responsible to the doctor, chemist or any of the other medical services for the fee paid. Unfortunately, down the years, in no community has society succeeded in redistributing its wealth at wage level in such a way that each person will be able to provide his own medical care, and for that reason the State has to come in. It has been accepted for quite a while that the State must provide services for those who really need them. There are many ways in which this can be done and it is in deciding which one of these should be adopted that the political Parties of this country take different sides.
Firstly, I shall take the Fine Gael Party. As I understand their policy, they suggest a comprehensive service for 85 per cent of the people based on insurance. That takes in the lower-income group who cannot afford to pay an insurance premium and, therefore, the premium should be paid by the State or perhaps by the local health authority. The upper 15 per cent are excluded and they are to look after themselves. This system of medicine is offered to the people with free choice of doctor and also with a means test. What I cannot understand is how it can be run without a means test because, firstly, no matter what way it happens, there must be some test to decide the 15 per cent who are excluded at the top. There must be some other system of eliciting information at some level to decide for what group the health authority or the State will pay the insurance premiums, the group we recognise as the lower-income group.
Secondly, we have the Labour Party. They offer the country a comprehensive health service such as the people of the United Kingdom have. Anyone who is aware of what has been happening in the UK during the past few years will not be anxious to have such a system of medicine for this country. It has given rise to a lot of trouble during the past 12 months. Doctors and State have been at loggerheads. It is not settled yet. Whatever is the reason—whether it is the patients, or the capitation fee, or whether the people of the United Kingdom have a different outlook from our people, or whether the doctors there are different—it is obvious it almost broke down at general practitioner level last year. The solution has not been reached yet. Certain terms have been put before a pricing body but they have not been priced and if they are not priced favourably to the profession, it is almost certain this row will start all over again.
Then we have the Fianna Fáil Party. It is true to say that whatever progress has been made since 1945 was due to the 1945 Health Act or the 1953 Act. Whatever defects the 1953 Act had, to my mind, it had no defects as far as the health of the people in the lower-income group was concerned. They have a comprehensive health service, though, I admit, they had not a choice of doctor, but this must not have been a big disability in spite of all the criticisms in the House during the last day or so because the complaint is that the managers and health authorities were not allowing more and more people into the lower-income group and obviously more and more people would not be anxious to get into that group if the service were not up to standard. Let those who will take credit for it, I think it reflects credit on all concerned in it. No matter what system you have that is good and giving benefits you will have others trying to get into it.
This further extension of the medical service, as envisaged in the White Paper, to my mind, goes along the right lines. In it once more we are deciding that we are prepared to help fully those who need full help; we are prepared to help partially those who need partial help. We have decided that the taxpayer will not be asked to pay more than is absolutely necessary to provide these health services and this, to my mind, is as much as any health service could be expected to provide if we are not to go for a doctrinaire approach.
Having decided all that much, we have got to decide what everybody expects from us. In the health services you have three parties: the patient, the medical profession and the State. A patient expects a few things from the health service. If he becomes acutely ill, he expects reasonably prompt and fairly efficient treatment. If necessary, he expects a bed will be available in a hospital immediately. He expects to be taken there in a proper mode of conveyance. When he reaches there, he expects he will get the highest standard of treatment possible and at all stages throughout the service he expects to be treated as a human being should be treated in any circumstances.
If he is chronically ill or less urgently ill, a patient expects treatement in his home or in a place convenient to his home. If that cannot be done, he expects hospital and consultant services will be available to him within a reasonable time and at a reasonable place. He expects that when he goes away from his home to get such treatment, those places will have the equipment and the staff to provide him with all that is necessary to diagnose and to treat his complaint. When that has been done, he hopes the treatment will be continued in his home by his family doctor.
Further, throughout all those stages and all those illnesses, a patient hopes he will get all this without any imposition on his finances so that when his illness is over, he will not be financially embarrassed by it. I feel that the scheme envisaged in the White Paper will do all those things.
The next persons concerned with the service is the medical profession. The general practitioners find themselves in a most unusual position now. They are expected to be on duty all the time throughout the entire week and they are expected to provide a service at all times if they are called on. Taking the overall picture, I think they do this and I was pleased that throughout this discussion most of the speakers agreed this is so. To my mind, the two most valuable things a doctor can offer to the community are his education in his profession and his time.
We all appreciate how important are his education and his experience but I think very few people appreciate the time factor in a doctor's life. His time is divided into two obvious divisions and one not so obvious. The good conscientious doctor will provide time to do his work. He will provide time for leisure and to spend with his family. But he must provide a third time which not many find it easy to provide—he must provide time for study. To my mind, his working time should be organised as far as possible. If it is not organised as far as possible, he will find it difficult to provide time for leisure and study. Some doctors succeed very well in organising their time, others not so well. Probably the district medical officer is one who does not find so much opportunity to organise his time. On occasion he is reluctant to do it. It is hard to say the reason why, but one feels it is because he is considered the State doctor. If he sets out to organise his time at all, he may find himself labelled discourteous, lazy or unwilling to work. He probably takes the easy way out. That organisation of time is the basis of good service to the community. Having organised his work time, he is able to organise his leisure time. It goes without saying that in a rushed world such as this, everybody must have some leisure. I am not going to labour that point. However, I propose to labour the third point—this question of study.
It is obvious that the Minister and his advisers are fully aware of the problem because they mention specifically in the White Paper they intend to provide post-graduate study for doctors. This will not be enough. The most they can provide probably will be a fortnight or three weeks, maybe every two years. It is hard to see it coming every year. But the doctor can and must spend a certain amount of his own time studying. He must keep in touch with recent advances. He must know what is happening around him. He must know what the recent advances in medicine have to offer his patients. If he has not read his medical journals, his patients are reading The Readers Digest and other magazines and are probably better up than he is. He always finds that the push is there. This is an aspect of the doctor's life very few outside the doctor's family appreciate. I would suggest to the Minister and to all concerned that it is an important aspect of the doctor's life. As far as possible, through propaganda and by one means or another, this aspect should be made as public as possible.
Having said all that, I may be giving the impression that the patients abuse doctors badly in Ireland as regards time. I would not like to give that impression. What I am afraid of is this. If we in extending our health services have the same experience as they have had across the water and in other countries, this is likely to happen. Possibly it is something that was not foreseen in other countries, but we should benefit by their experience and realise that it is probably one of the biggest abuses that has occurred in Britain, giving this capitation system and State medicine such a bad name as far as we are concerned here.
In the White Paper patients are offered a free choice of doctors. I do not think anybody can find fault with this, but the question comes up: at what level will choice of doctor cease? This was raised yesterday by Deputy Corish in the form of a question: Whether there would be a choice of doctor in local authority hospitals? The question was answered fairly reasonably, but it does not cover the whole problem. The Minister envisages the health organisation of the country on a regional basis. When that is done, will a patient have a choice of specialist from one region to another? In other words, will the patient living in region A, if he happens to think the specialist in region B or region C is better than the one he has in region A, be given the right to go to that particular specialist? This is important. Anybody dealing with people in the country appreciates that this occures several times a month. I am not going to exaggerate. It is a question to which the Minister should turn his mind. No doubt it will cause difficulty in administration, but until you reach that stage and give them this choice, you are in fact not giving a free choice of doctor throughout the whole scheme.
Another aspect is the question of remuneration. I understand each Deputy has received a document dealing with remuneration and I hope they have all read it by now. As pointed out in that document, there are three or four different systems of remuneration. It is felt by the medical organisations in this country that the fee for service is the best system of remuneration. Under the fee for service system, you are paid for the work you do, and if you have to do any extra work, you get paid for that. This is not the case under the capitation system and under the salary system. I am fully aware that this is a big problem, with big financial implications, but this is the system the majority of the doctors here believe to be the best one. It is only fair to say there are some doctors who feel that the capitation system would suit them best. As the Minister has to discuss these matters with those people afterwards, I do not intend to pursue this subject any further.
There is one aspect of the health services I should like to advert to and to which I do not think anybody has adverted. At times when it has been my duty to examine people seeking jobs, I often wonder is this a futile operation. This was brought to my notice particularly some years ago when it was necessary for a child applying for a county scholarship to submit himself for medical examination. At that time it meant, if the doctor turned the child down because he had some health defect, the child could not sit for the county scholarship. I always felt at that time that this was wrong because the delicate child, to my mind, is the child who should get the scholarship. If there were a limited amount of money available, perhaps the delicate child should get first preference. Over the years there has been a change of view on that, so much so that that examination is removed and in fact county councils are giving scholarships for children with defects. That is as it should be.
I wish to push this question further. In doing so, it probably enters the province of the Minister for Finance rather than the Minister for Health, but as it is his responsibility to look after health, I feel I should mention it here. When people come for an examination, having applied for a job in the Civil Service, county council or other such place, this question again comes up. If this person has a health defect, you must turn him down for the job. I think this is absolutely wrong. There is no good in talking here about improving the health of the people and helping to alleviate their defects, unless we are going to place them on the same level as healthy people. Instead of having those people examined with a view to excluding them from particular jobs, it should become the policy of the State to employ them.
I say "the policy of the State" rather than the policy of private companies. It would be unfair, I think, to ask private companies to do this. On the other hand, unfortunate people suffering from rheumatism, defective hearts, diabetes, bronchitis and various other ills, should be taken into the public service and into the service of local authorities, having the same opportunities and receiving the same treatment as the healthy. Until such time as policy is reoriented in that direction, we will not have done a complete job. This is much more important than extending health services to those who cannot afford to pay for them.
It would, of course, be a matter for the Department of Finance. There are financial implications in it and there would be objections to it, but I believe a policy could be worked out. The public services and local authorities should be made to absorb these people and the onus should not be placed on the private employer. Until this is done, we shall not have a complete health service. Furthermore, all are not born with equal opportunities. If one is born with a defect and, because of it, is excluded from Government jobs, then there is no equal opportunity. It is time this aspect was adverted to so that families and the unfortunates who are affected will know that there is an employment outlet, and not a limited outlet at that. That is one of the most important points I can make in this debate.
I have heard a good deal of complaint about the building of dispensaries. This is hardly a matter for the Minister for Health. In Roscommon, we have built a great many new dispensaries, first-class buildings, properly heated. What is done in Roscommon can surely be done by every other health authority, if the will to do it is there.
The gravest defects in our present health services are those which leave no scope for people in the middle-income group to be supplied with teeth, hearing aids and glasses. Some of these items are very expensive and very few can afford to supply them themselves. I hope these matters will in future get priority. I think these services should be provided before any of the other services mentioned.
Reference has been made to the mentally handicapped and the aged. It is unfair to criticise the Minister because the problem has not been resolved. It is a big problem. We have had it for years. It has never been faced up to fully, but, since the Minister took office, he has made great efforts to come to grips with the problem. One of the biggest difficulties in coming to grips with it is that it is so hard to get people to do anything about it. It is very hard to convince people that money should be spent. A start has been made and I have no doubt progress will continue to be made. No matter what we do here, no results will be achieved unless there is goodwill everywhere. This is where the third party, the State, comes in. It will be the business of the State to ensure the services are not abused and to ensure that those responsible do their duty. The biggest problem will be in providing the personnel to do the work. As services expand, the State will be up against it because medical appointments elsewhere are very attractive. It often amazes me to see the number who return to work here, remembering what salaries are like in other countries. If there is an increased demand for specialists, these will have to be brought in from outside. It may not be very easy to get them to come in.
I should like to pay tribute to the Minister for the work he is doing. He has been criticised for not doing enough and not going fast enough. I think those who criticise realise that medicine is a costly business. No community in the world, no matter what system has been adopted, has succeeded in giving free health services at all levels to everybody. There is always some stop and stay in every community. We are not a very prosperous community and it is my belief that the Minister and the Government are giving a fair share of our prosperity in the health services to those who need it.
Deputy Gibbons spoke very comprehensively on the health services in general. He referred only in passing to the problem of the mentally handicapped. Deputy Coughlan dwelt at some length on this problem. It is a problem that deserves more than a passing mention. It is a problem which is causing very serious concern and istress in many households. It does not get, in my opinion, sufficient space in the White Paper. We are not told enough about the Minister's intentions for the future.
Deputy Gibbons says he is aware of the problem and he has been trying to make the public aware. I do not think it is necessary to build up any public opinion whatever in relation to this aspect of health services. I am a member of a board catering for the mentally handicapped and we have at the moments a waiting list of about 300. I do not know what the position is generally throughout the country, but I am aware that every public representative is plagued with people in serious distress coming to see if he can do anything or use any influence to get a child or, perhaps, two children into an institution catering for the mentally handicapped.
It is not sufficient for the Minister to say that he is in receipt of the Commission's report since last April and that he intends to deal separately with the problem in another White Paper. These unfortunate people have been waiting for years while this special Commission were sitting and while they were producing their report. It was hoped that, as soon as the report came to hand, the matter would be treated as one of urgency and every effort would be made to meet the plight of these people and cater for them. The White Paper states:
The Report of the Commission of Inquiry on Mental Handicap, published in April, 1965, is under consideration by the Government. As it is intended to publish a separate White Paper indicating the Government's decision on the recommendations in this report, it is not proposed in the present White Paper to discuss the development of the services for the mentally handicapped.
Whatever information is available to the Minister should be made available to the House so that the anxiety of these unfortunate people may be allayed. Let them know that the problem is being treated as an urgent problem. Additional beds have been provided in recent years in various parts of the country and arrangements are under way to provide more beds. However, every scrap of information or any tentative plans the Minister has for the future, should be made known now. The Minister and the Department should let the people feel they are sincerely concerned about this problem and are doing everything possible to meet it.
There is another problem which gets only passing reference in this White Paper. It is a problem to which I attach a good deal of importance and about which, in the course of the past couple of years, I tried to get something done. I have put down a number of questions in the hope of getting diagnostic facilities made available on a national scale for cervical cancer. This is a problem in relation to which we have been dragging our feet.
Some years ago I was supplied with the limited figures available in relation to the number of preventable deaths which occur annually from cancer of the cervix. I was appalled to think that while we could be saying lives here, we were doing very little about it. In the Dublin Health Authority in recent times, we have got permission to set up a small diagnostic centre and we have employed two nursing technicians. I believe we have also got permission from the Department to employ a cytologist. There appears to have been some difficulty here. The Appointments Commission are making this appointment and have advertised unsuccessfully at least once. Here again the Minister's intentions and the limited service available should be made known throughout the country, and it should be stressed how important it is for people to avail of this service. An indication should be given of the number of deaths that occur annually, deaths that can be prevented if only these simple diagnostic facilities are availed of. When the Minister is replying, would be indicate why it has taken so long to provide coverage for this on a national basis? My information is that it requires only a very limited investment to prevent a very large number of deaths from cervical cancer. This is one of the few forms of cancer where something can really be done and it is extremely disappointing that we have failed for so long to provide these facilities.
I have great sympathy with the Minister in the circumstances of the present time. He has come into a Department that has been practically stagnant for years and where, in regard to health services, very few improvements have taken place. There is an enormous job to be done. I believe the Minister has the energy, the ability and the urge to do this job, but he finds when he looks around there is not a shilling left in the kitty with which to do anything.
The Taoiseach has already announced that any improvement in the health service, like educational facilities, must await the advent of better times. We have no indication when these better times are expected. In every page of the White Paper with which we have been supplied it is a question of wait and wait indefinitely. There is no period given for doing anything. To the extent that certain improvements are indicated we are glad but I am very critical of this White Paper which vaguely describes the long-distance views of the Government in relation to possible improvements in the health service.
The first line of the introduction to this White Paper reads: "This White Paper describes briefly the origins of the health service..." The people generally are not concerned about the origins of the health service. The people want to know what improvements are going to take place and when, and "when" is the important thing. The third paragraph on the same page says: "The changes proposed are complex and fairly costly. Their complexity rules out any question of their introduction in the immediate future...." What is meant by the immediate future? When will the changes proposed take place? Is there any indication as to when these improvements will be effected? I cannot see anything specific in this White Paper. It would be far better if the proposals were much more limited and if the Minister would say that the people were going to get the benefit of these improvements in six months' time or in 12 months' time, but no such commitment is there.
The Minister says on page 3 of his statement:
The White Paper proposes a number of important changes in the general medical service. It is intended to introduce a choice of doctor in the service and, we hope, a choice of chemist.
These are definite improvements which we are all well able to recognise. They are improvements which Deputy O'Higgins had recommended ten years ago. However, can the Minister tell us when the people can expect these changes, at the end of what period? Is it at the end of a year or two years? That is what is important to the people.
The Minister further states:
It is intended that the limits for the categories eligible for the service will be clearly defined instead of being subject to individual local interpretation with a rather vague legal formula as at present.
The second part of that statement indicates that the humiliating aspect of the health service remains, that is, the means test, that the Minister is determined to retain the means test and that the people will be denied, for an unknown period in the future, what all the countries in western Europe have at the present time, that is, a comprehensive medical service for the vast bulk of the people. There is no country, as far as I know, in western Europe, that has not got that for the vast majority of the people. The United Kingdom, Denmark and Sweden apparently have 100 per cent such coverage. Austria, France and Germany have nine-tenths coverage. The Netherlands, Norway, Switzerland and Spain have four-fifths coverage. Belgium has three-quarters and in Luxembourg, Portugal and Italy the vast majority of the population are covered. I think it is right to say that in most of those countries payment for those services is based on insurance.
Various people have condemned the Select Committee on Health Services set up some years ago. I served on that Committee for a period of three and a half years. Mark you, I think it did a lot of good in so far as it has helped to convince the Minister, or perhaps his predecessor before him, that enormous improvements were urgently needed. The Minister says that the basis for his White Paper came in the main from the evidence collected in the course of that inquiry. All I can say is a very large volume of evidence was collected from the various interested and associated groups who were allowed to express their opinion. That opinion was in favour of a comprehensive health service for the vast majority of the people.
Today, Deputy Gibbons, who gave quite an enlightened discourse on this subject, said he did not understand the Fine Gael proposals in this regard. The only thing he seemed unable to understand is how one could eliminate the means test and still have 15 per cent of the people excluded. Of course, the answer was that those 15 per cent excluded themselves because they were not obliged to make a contribution and they were people who were so obviously in the upper income group that it was easy enough to recognise them.
The Minister, in the course of defining clearly the eligible categories, has not said to what extent this will extend the services. He has not given any estimate of the change that will make. We know, at the present time, that approximately 30 per cent of the people are covered. What percentage will be covered when the Minister's yardstick is used? We all know it is quite wrong that in the poorest county in Ireland, County Leitrim, something like 24 per cent of the people are covered by medical cards and in counties like Carlow and Meath, 40 per cent and 50 per cent of the people are covered. That is all wrong and it is something which should have been looked into some considerable time ago. The local yardstick should be eliminated and some sort of more specific measurements used.
I am glad to see it is proposed to do that in this White Paper, but the Minister, as I say, has not indicated whether this will bring in a greater percentage of the people for the purpose of general medical services. Is it intended, in the places where you have approximately 40 per cent or 50 per cent of the people covered by general medical service cards at the moment, that they will be reduced to 30 per cent? Is it a levelling up and down so that we will eventually arrive back at approximately the same figure, only that we will get a more equitable distribution of the health service to the people but using a different yardstick and by using different means of dealing with the problem?
That is one of the things which the Minister should have indicated. He should have indicated more clearly how those various improvements outlined in this White Paper will be paid for. He should have indicated their cost, first of all. The cost, he has told us, will be approximately £4½ million. When are we to arrive at that £4½ million expenditure? Is it at the end of one, two or three years? At what date will we be involved in that additional expenditure? When we are involved in that additional expenditure, where is it to come from? The only thing the Minister has done is to indicate that the demand for health services from the rates in the present year will not increase and that the Department will pay 100 per cent of the amount in excess of what was paid for health services last year.
That is one of the things that have created a good deal of confusion in various counties. I think something like this was said in the course of some of the explanations or statements that were made. If the health services in a particular county cost pound for pound last year and adequate provision had been made, there would be no change in the present year or the future year, 1966-67; it would still be pound for pound. If there was under-provision last year, say, to the tune of one shilling in the pound, this year it would be 21/-and if there was over-provision last year, to the time of 1/-, it would be reduced by 1/- to 19/-. That is over-simplification and it has led to a good deal of confusion and a good deal of upset in various counties where an increase in the rates has already been sought by the county managers. This, I know, has arisen in some cases to meet existing debit balances but there are other cases in which many public representatives, and the people generally, do not appreciate that it is not 50 per cent of all expenditure in the health authorities that is met from the Department, that there are certain expenditures which the Department do not meet, paying 50 per cent. An example of that is loan charges and bank charges. Where there is fairly considerable capital development in the coming year and where these loan charges are heavier and bank charges are heavier, there would be, on that account alone, an increase in the rates for that particular purpose.
Mr. O'Malley
What loan charges is the Deputy talking about?
I am talking about loan charges for building dispensaries, hospitals and that type of thing.
Mr. O'Malley
In the coming year?
Yes.
Mr. O'Malley
My interpretation is that 100 per cent will be borne by a source other than the rates.
One hundred per cent will be borne by a source other than the rates?
Mr. O'Malley
Yes, with regard to a new dispensary or something else new.
As far as my information on that goes there is eligible expenditure, and expenditure in local authorities which is not eligible, for a 50 per cent Department grant. I think the Minister will agree I am right in saying that loan charges can be one of the things and bank interest can be another. However, I think perhaps it is one of the things that have in some way led to misunderstanding in relation to those matters.
Mr. O'Malley
We will bear the loan charges. I am correct in my interpretation.
You will bear the loan charges?
Mr. O'Malley
Yes. I sent out a letter, last Saturday actually, to each health authority and every mental health board clarifying exactly what we do, because, as the Deputy says, there was some confusion.
Does that also apply to bank interest? You pay 100 per cent of the excess on bank interest as well—any expenditure?
Mr. O'Malley
But surely that is portion of the project? If you borrow money, you have to pay it back, principal and interest.
Quite.
Mr. O'Malley
A rose by any other name—whether it is a bank, insurance company or the Local Loans Fund.
I am very pleased to hear the Minister saying that if a health authority provided sufficiently last year for their health services, there will be no increase in the payment for health services in the present year.
Mr. O'Malley
That is correct.
From any source?
Mr. O'Malley
That is correct.
I am very glad that point has been clarified.
Mr. O'Malley
The important words used by the Deputy are: "If the health authority provided adequately last year."
If there is not a debit balance.
Mr. O'Malley
You differentiate between the amount which last year's estimates met and the actual cost during the year. For instance, last year you might have estimated for 20/-in the £ on the health rate for the local authority and during the year there might have been increases in salaries or something else which you did not foresee.
That would be last year's debt in any case. I can appreciate that.
One of the things to which I should like to refer is the extension of the income limit, for the purpose of institutional and other services, for the middle-income group. That, of course, is a real asset and is something which is appreciated by everybody. There is a figure given in the White Paper for the cost of this and, in fact, it surprises me that it is as high as it is because of the fact that the voluntary health scheme has been such a success and so many people are now covered by it. I would say that the vast majority of the people up to the £1,200 income limit who would not be entitled to general medical services would now have themselves covered by way of voluntary health insurance. Of course, I assume that if they are covered by insurance, they do not have to be covered by the improvement in the health service for the middle-income group suggested here.
Mr. O'Malley
Or the other way round.
It might be as well if the Minister would clarify that.
Mr. O'Malley
I shall refer to that in my reply. It is an important matter.
Is there a refund?
Mr. O'Malley
I would not say there is a refund; I would say there is a reduction in contribution. If you now come into the category of the £800—£1,200 in which you were not hitherto and you were in the voluntary health scheme, it now means that your contributions to the voluntary health scheme will be lessened because you are now entitled to services to which you were not hitherto entitled.
I am not aware that the voluntary health scheme has made any reference to that fact publicly.
Mr. O'Malley
The general manager made a very comprehensive statement on it.
Is the money saved, then, to be used to extend benefits or to reduce contributions?
Mr. O'Malley
To extend benefits. As a matter of fact, the voluntary health insurance body published a very comprehensive leaflet on this matter.
It is no harm to have that aspect of it made clear.
I shall now turn to the question of drugs being supplied at a reduced cost. That is not new, of course, as the Minister knows; it has been in existence for the past two or three years in some certainly, if not all, of the health authorities. I have never had any real difficulty, in hardship cases, in getting the health authority to meet their difficulties, even though, on paper, their income was quite well above the limit laid down for the middle-income group. It has been my experience, in such cases, that expenditure on drugs has been met pretty generously by the health authority. It is something which caused a lot of hardship in various households for a long time, but not for the past two or three years since a directive was sent out from the Department that this should be done. It is mentioned in this White Paper and one might get the impression—if one were not familiar with it—that it is something new. It is not.
While I think this White Paper contains many excellent proposals for the future and makes many badlyneeded improvements, where it falls down completely is, first of all, that it fails to accept that there is a need for a comprehensive medical service, and that it refuses to recognise that, although all the information available to the Minister should indicate that it is extremely desirable to have such a comprehensive service. When it refuses to see and to accept that, even though all the countries in Europe have such a service and even though we are very ambitious to get into Europe and hope we will be in Europe by 1970, we are still working on our health services on the basis of improving an existing health service, on the basis that we must have here at all times a means test and that the people who get this complete cover for health service must first prove their eligibility. It is very unfortunate that we should call on our people to prove, first of all, that they are poor before we will give them the service to which they should be entitled.
Paragraph 50 of this White Paper says:
A persistent basis of criticism of the present service lies in the different standards of eligibility which are a consequence of local variations in interpreting the formula for the lower income group mentioned in paragraph 10, and in the fact that the standards for eligibility are not published. Local health authorities must operate the law as they find it and variations such as these are probably inevitable in the operation of this somewhat vague criterion. It is, therefore, no reflection on these authorities that the Government accept these criticisms as valid.
That is nearly an apology. I mean— they are either right or wrong. I repeat:
It is, therefore, no reflection on these authorities that the Government accept these criticisms as valid.
Paragraph 51 commences by saying:
It is proposed to introduce legislation under which the Minister for Health would make regulations specifying the classes of persons entitled to participate in the service.
That is something which is long overdue and something we are all very pleased to see coming about.
One thing which interests me is that it is proposed to do away with the dispensaries completely, to sell them to the doctors or do something else with them. Where are the clinics to be held? We are hoping to improve the dental services, the ophthalmic services and the aural services. Where are these services to be given? It was always very convenient, especially in the poorer areas, to have a well equipped health centre adjacent to a school, so that a mother could bring two of the children to school and one or two of the other children to the health centre. We should have health centres convenient to schools where these examinations can take place. It would be a wonderful thing if instead of disrupting the work of the schools, the children could be taken to an adjacent health centre which was fairly well equipped for examinations. It would be well worthwhile maintaining quite a number of these modern health centres for that purpose. They are fairly well equipped already and where they are not well equipped, the equipment should be improved. I think it would be the loss of an asset if these centres were to disappear, and if the services now provided in them were to be provided in future at the doctor's home or at accommodation he would provide adjacent to his home.
I want to refer now to something which occurred during the week as a result of a reply to a question raised by Deputy O'Connell about the pharmacies of Dublin Health Authority areas. In answer to a supplementary question, the Minister made a statement that I feel he should not have made. He said that two people who were identified had been summoned to his Department and that certain aspects of the work of the pharmacies had been particularly inept. All I can say is that all the evidence that I can get in relation to this matter indicates that the reason why the services were not better at the pharmacies of Dublin Health Authority was the failure of the Department to sanction various proposals over the past three or four years which were intended to improve the service. Without this permission from the Department, it was quite impossible to carry on as they had been carrying on. That was indicated more than once to the Department, and certain proposals were made which were not sanctioned.
Mr. O'Malley
That is not correct. I will deal with it when I am replying. That is a serious statement and I would not have made the statement that Dublin Health Authority pharmacies were inept if I did not think they were. I represent the people vis-á-vis the Department and the health authorities, and my first consideration is the patient. They were inept.
I am sure the Minister would not make that statement if he did not feel they were inept. I will give him credit for that. There are two sides to the statement and I think it is rather unfortunate that the people who were criticised were not in a position to defend themselves. It has always been the practice in this House not to criticise people who are not in a position to defend themselves. I have worked very closely with these people since 1961. I was chairman of Dublin Health Authority and I worked in very close association with them. They are doing an enormous job and the top ten of that organisation are as good as you will get anywhere in Europe. You could not find a more able and dedicated group of officials than those people. I am saying that in public and I will not get any particular benefit from saying it. I was not in any way prompted to say it. I have always felt that way about them. One thing you can say about Dublin Health Authority is that the people at the top are murdered.
The Minister in his White Paper speaks of reorganising the administration of the health services on a regional basis. That has been done in Dublin city and county where one authority is looking after one-quarter of the population. I am giving my personal view from what I have witnessed at close quarters. I think that is far too great a number for one health authority to cater for. I remember when I was chairman of the authority, we had a visit from one of the late President Kennedy's expert hospital administrators. I remember when a certain person from the Department was giving him a look at what we were doing in relation to health, the man from the Department said to the American: "One of the greatest things we have ever done in this country is the amalgamation of the health services." I asked him what number of people would he consider to be the optimum number for one single health authority to deal with and he had no hesitation in saying: "one quarter of a million." That was his idea of the upper limit of the population that could be adequately provided for by one health authority. All I can say is that the top ten or 12 people in this organisation are completely overloaded and are carrying so much responsibility that they will not continue to carry it. The whole question of reorganisation and producing new health authorities is something the Minister will have to consider very carefully.
It is proposed to take this out of the hands of the county councils, but I think the county councils will carry on with the same number of staff, as if they had not got the responsibility to administer the health services. I have read the White Paper and the only justification mentioned in it is that if the State pays a very large proportion of the health services bill, then you cannot have a situation in which the health services will not be administered directly by the State. In my view, that is a vote of no confidence in the local authorities. It is tantamount to saying that because the State is providing a large portion of the money, they would use it irresponsibly. I do not believe that, because I think most of the people in the local authorities are responsible and intelligent, and they realise that even though the money is coming from central taxation, they themselves are making a large contribution towards it. What I think will happen is that we will set up another administration machine. It will be an expensive machine and it will provide more jobs for the boys. I do not think it will save any money or improve the health services.
If we look at this whole problem seriously and decide on what type of services we should have, our local authorities are quite capable of administering them efficiently. I am well aware of the fact that institutional services and hospital services must be regarded on a regional basis, but I see no reason why the various countries could not get together and form a region and have the institutional services provided on a services rendered basis, as we do in Dublin city and county and in Dún Laoghaire. We pay for this type of service on a services rendered basis and there is no argument, row or discussion. It works quite well and it is something that could work quite well throughout the country without setting up another new and expensive organisation.
I have dealt with most of the matters to which I wanted to refer in relation to this White Paper. I shall conclude by saying that it is regrettable—when a major reshuffle and reorganisation of the health services was proposed — that the Minister has decided that the health services we are to give our people must still be based on the Medical Charities Act, 1857, that was brought in here just as a famine relief and that we still hold and intend to hold all the despicable aspects of this means test to which the people have been objecting for so long.
This White Paper stems from the 1953 Act and reflects the revised thinking in the Department and the experience gained in the administration of this Act. I am sure it was considerably helped by the evidence given before the Select Committee on Health Services. It is also designed, I think, to fill out the services provided for or promised in section 21 of the 1953 Act. This White Paper is a plan, a blueprint, of the health services. The objectives are fairly clearly set out. Some of the objectives, the Minister said, may not immediately be realisable because of financial stringency but that should not deter their preparation.
The White Paper is a spur to action. Any businessman, any farmer, any industrialist, will make his plan so that he will be able to assess the resources available to him. He will know what resources are available to him so that he can mobilise them. The Minister has done this. He set his targets and said: "I want about £4½ million." We know where we are. How he will get these resources is a matter for the Oireachtas. There is nothing final as yet. He has made this very plain in this White Paper. Discussions are being held and will be held with the doctors, chemists and other professional organisations. He has listened here to two days' debate on the White Paper and possibly he will have to listen to another days' debate. He will have the benefit of articles in the public press, letters, and what have you, with the result that whatever legislation will emerge from this will be well-informed legislation.
This White Paper is nothing more than a sketch plan. Legislation is foreshadowed and the result will be a certain modification of the White Paper which will not abrogate the basic principles on which it is founded. We are not giving a free-for-all to everybody but we shall also see to it that nobody will be in want. These principles are not abrogated in this White Paper and will be preserved in future legislation.
Many improvements are visualised in the White Paper. Everybody welcomes the choice of doctor. As Deputy Mrs. Crowley said here last night, we all love a choice, a choice of doctor, a choice of clothes and a choice of many other things.
Mr. O'Malley
A choice of TV.
There is a natural desire to have a choice. When we get it, and when we get this freedom, the pattern of medical attention will not be changed one per cent, but we are happy to have the freedom and that is the basic point about this.
It is claimed that the new health proposals represent Fine Gael Policy. Deputy Coughlan said that they represent Labour policy or his own policy—I could not quite decide which he meant. I do not like all this talk about "I thought of this before you did" and so on. There are plenty of fellows down the country, heaps of unknown Ministers for Health, silent Ministers, fellows drinking pints in a pub or maybe mending some tractor part, and they also thought of this so there is no use in one side or the other side of the House saying: "We thought of it first".
(Cavan): Fianna Fáil turned it down: That is the point.
Our Party has the Minister who brought it in—and that is the point. Credit should go to the present Minister for Health who brought it in.
(Cavan): He has brought in a White Paper.
Deputy Lenihan must be allowed to make his speech without interruption.
About that, its paternity is terribly in doubt. Whether it is by O'Higgins or O'Malley or Coughlan I could not tell you, but the maternity is clear and it is his job now—the Minister's job—to cuddle, cosset and care for this infant and mother it through——
(Cavan): I hope it will not be stillborn.
It is born, kicking and howling for the past two days here. It is a lusty child.
It is not born yet, according to the Minister. He has not the money to pay for it.
Deputy Lenihan must be allowed to speak without interruption.
These interruptions are helpful. There will be a lot of consultation regarding doctors' fees, and so on. Deputy Gibbons was very helpful in his contribution. With goodwill on both sides, and the over-riding desire for the full and effective care of the sick, I think it will go through.
On the subject of drugs, negotiations are on foot to provide a more economic service through the normal retail channels and that is welcome. Deputy Fitzpatrick was afraid that the heavy hand of the Civil Service was falling in relation to drugs but I do not think that is the position. I have been discussing this matter with doctors. They welcome the preparation of this national formulary because it is done in consultation with the Department, doctors and chemists. I hope it will lead to efficiency and economy. It will not prevent the prescribing of expensive drugs. It is merely a guideline for chemists, doctors and medical people and that is all it pretends to be. Even Deputy Clinton paid tribute to the manner in which the drugs are administered and their costs are handled in his public authority.
I now come to this question of the lower, middle and upper-income groups and the issue of medical cards. On page 28 of the White Paper, there is a list which gives the percentage of population on the general medical services register. It ranges from Carlow County Council at 47.1 per cent to 24.4 per cent for Leitrim County Council and, coming to the Minister's area, 26 per cent for Limerick County Borough. It indicates the subjective approach to this whole problem.
With the fixing of limits of remuneration, the exclusion of the income of children and the abolition of the family income concept, we shall get away from the means test when these eligibility limits are fixed by the Minister. The means test does not arise in the lower-income group. I feel it will speed the examination of claims and will take away any suggestion of a means test. These regulations are subject to agreement by the Oireachtas and will generally be known as a result of wide publication which, in turn, will save Deputies, county councillors and others an awful lot of stupid and unnecessary trouble. Coming back to percentages, if we all followed Deputy Nolan down to Carlow we might have 50 per cent of the people in the lower-income group. You have ten per cent who are looked after by the voluntary health insurance scheme, about 300,000. You are mighty near a comprehensive service. I suggest the Minister should take a kindly but fairly hard look at the causes for these variations between counties, especially in the counties which are over the national average.
Another point on which there seems to be a difference of opinion in the House is the hospital charge of 10/-per day. I thoroughly agree with the Minister that these charges should be retained for some very good reasons. First, this is much below the economic cost but the principal reason is that it would disimprove the bed turnover if the charges were removed. If a person knows he has to pay nothing, he stays longer in the hospital bed. The charge of 10/- a day is a great incentive to him to get well. In any event, if there is a hard luck case, there is always some means of relief. If anything, with the increase in incomes to £1,200, I should be inclined to increase this charge. If it yields about £500,000 now, it might be worth another £150,000.
(Cavan): The machinery is there to do that and it probably will be done.
I know it is for that reason that there is relief on the out-patient charges for X-rays. The more we can have domiciliary treatment and the more out-patient service and home nursing there is, the more beds there will be available for urgent cases. We can have more domiciliary care with the increased number of district nurses especially in the case of aged people, thus freeing costly and much-needed beds.
In Athlone we have a voluntary organisation reconstructing a building to act as a social centre for elderly people who come there three nights weekly to hear music, play cards or enjoy television and so on. Where they are single people, they can also be visited. We propose in Westmeath County Council to give a contribution towards this work. I should like to read a report from our county MOH on the question of the care of the elderly and chronic sick. Some significant statistics are given here. It states:
Of greater significance was the 40 per cent rise in those 85 years of age and older between 1951 and 1961. In 1951 there were 13,285 persons in this latter age group in the Republic and in 1961 the figure had risen to 19,535.
Again he says:
Many will require help to continue at home and it is in this field that the greatest need exists for an extension of the care and welfare services given through the Local Authority and voluntary agencies. The elderly and chronic sick cannot survive in comfort at home without a "home-help service,""meals-onwheels" nurse visits and nursing aids.
This report is made by a man in the field whose opinion must be respected. Later on he says:
Until these services are made available, the strain on institutional accommodation will continue. Elderly persons are much happier in their own homes or in small residential homes forming part of a normal community and they must be facilitated to continue in this happier environment.
Paragraph 84 of the White Paper says pretty much the same thing:
... if the best value is to be obtained for the aged from the health and assistance services and the efforts of the voluntary agencies there must, at the central level, be a clear line of responsibility for seeing that there is the necessary co-ordination of the various services.
The Minister proposes to do that. It is proposed that this will be the responsibility of the Minister for Health and that his Department with the cooperation of others will encourage local co-ordination. Such efforts should be strongly encouraged. We contribute to this in County Westmeath. It is sad to see old people shuffling about county homes but it is sadder to see them falling into open fires, as frequently happens. Any help given in this direction on a voluntary basis should be supported even to the extent of £1 for £1. People feel they have a responsibility in respect of the elderly. Most of us are parents and we shall, if we live, become old people ourselves. We can say: "There but for the grace of God..." The Romans and the Chinese have a tradition of reverence for the aged. It is an emotion that is easy to evoke and it brings out the best in people.
On the question of finance, the Minister is casting about for possible sources of revenue. Would he consider asking his colleague, the Minister for Finance, to allow as a deduction from the profits of a business, any donation given to the building of a home for the aged or some such project, or some donation given towards the purpose of helping these people? I should prefer there would be some specific donation rather than some general help, such as building a home or a clinic. Big money prizes are offered for golf competitions, dairy queens and beauty contests and rightly so, as the donors get good publicity. In giving that money to provide a home for old people or to pay Jubilee nurses to look after them or some specific aim of that kind, so long as it is a definite object, the donor could be assured that it will be allowed as a deduction and a good bit of revenue might be obtained. I do not know the position with regard to estate duty, whether such gifts are exempt, but you could have a case of somebody dying with a bad conscience and bequeathing a few thousand pounds towards a geriatric unit. He would get the same publicity as if he gave a golf trophy or provided prize money in some other way for some competition but it would serve a dual purpose of aiding a useful, charitable, worthwhile cause and ensuring publicity for the donor which is only proper.
Coming back to the question of voluntary effort, I think we could mobilise more voluntary effort for the aged. One could organise flag days through voluntary effort and the Department could contribute £1 for £1 for the benefit of the aged.
Training for employment is another fruitful field of voluntary service in which good work is already being done and, as in the case of the aged, it is something that excites sympathy and secures generous support.
I should like to stress the preventive services. Again Dr. Flynn, our county MOH, had something to say on that subject. In effect, it was that we should never let up; we should not become complacent. Incidentally, he reports an increase in tuberculosis. It is very slight but it is still there. He says:
Many times in previous reports I have warned against complacency and the statements that the problem of tuberculosis has been solved. This is far from fact—the disease is under fair control but there are many years of hard work ahead before the goal of eradication will be reached. Despite much publicity there are still many persons who fail to avail of X-ray facilities provided by the mobile mass X-ray units. Until there is 100 per cent response of all adults to these X-ray sessions persons with advanced disease will be discovered each year. Of the 31 new respiratory cases registered in 1964, at least seven had advanced disease of both lungs and positive sputum.
Would the Deputy please give the reference?
It is the annual report of the county medical officer of health for Westmeath. I am sure all these reports are in the Department. These reports are valuable in that they are reports from men in the field. We need not be complacent about any infectious disease. I was interested to hear reference to some new device but the point is that all these are free services because any infectious disease affects the community.
The dental, ophthalmic and aural services under section 21 of the Act are to be extended to cover all schoolgoing children. This is frightfully important, as important as the care of the aged and rehabilitation. Preventive medicine in the care of children up to school leaving age is essential and should get first priority. These children are the citizens of the future and by looking after them now, they will have the mens sana in corporate sano which is a must. Last night Deputy Coughlan seemed to have solved the dental problem and he told us about a dental mechanic and called him by a strange name—I do not know what it was.
Mr. O'Malley
A prosthetist.
This man spent three years on the Continent and took impressions and the Deputy wanted him to be brought in to play a more active role. Deputy Coughlan did not make an impression on me.
I cannot conclude without paying a tribute to our general practitioners. I would not be one for all the tea in India. They are called out in the middle of the night and I like to have my night to myself. I know of general practitioners who did not furnish bills to people in the middle-income group because they knew that their circumstances were not good. I am sure Deputy L'Estrange knows doctors who are dedicated men. There may be some bad ones amongst them but there are bad ones amongst us all. On the whole, they have done a fine job. Perhaps when they are called out at 3 a.m. to a midwifery case, they may groan but they go willingly. Certainly tribute should be paid to them.
Some poor descriptions have been given of Dublin dispensaries. The Minister will tell us when he is replying what he will do with many of the other dispensaries in the country, many of which are good. There will be parts in the west where you will always have dispensaries and only one doctor, but that cannot be helped. There are some beautiful dispensaries and some good use will be found for them. A good thing about the abolition of the dispensary system is that it will do away with class distinction between the lower-income and the middle-income groups.
(Cavan): The means test will prevent that.
It will be removed completely as far as the lower-income group is concerned. There will be no means test for the average man in the lower-income group. As far as the medical costs are concerned, the only time a means test arises is when a man looks for a reduction in the hospital bill. The expression "means test" had a kind of emotional connotation in the past, but we have moved a long way since that.
I dealt earlier with the so-called paternity of this paper and I would appeal to all Deputies that whenever important social legislation is going through the House—and we had some in recent times: the Housing Bill and the Succession Bill, and we will have Bills arising from this White Paper and regulations being laid before the House by the Minister—to try to have as broad a measure of agreement as possible. We must cease playing politics. You do not play politics with houses or with health. Both the Housing Bill and the Succession Bill had a large measure of agreement. When the Minister is introducing whatever legislation he may be introducing, let us have as great an element of agreement as possible. In the past two days, we have got rid of a lot of material from our systems and now we can write off all that, and if the same spirit prevails, if we are actuated by the same spirit, we will put that legislation through quickly.
As regards finances, we will have to leave that to the Minister. I see him advancing over a broad front. He is not tied to knocking of one section now and another section at another time. His estimate is up by £2 million, whatever pruning was done, and he has substantial projects on hand. Whether it takes him one year or two years, whether all this is done by 1967 or 1968, does not matter as long as we are progressing and advancing towards the goals in the White Paper. Deputy Coughlan called it Aesop's Fables, although he admitted finally that it was a White Paper, which was an admission for him. Whichever way it goes, I wish the Minister the very best of luck. He will have his work cut out. Many tributes have been paid to him from all sides and whoever thought of the choice of doctor, or the choice of hospital, or of this thing or the other thing, there is the man who is going to legislate for them——
When?
——and who published the White Paper. He is the mother, whoever is the father.
Who will get the money?
For what?
To implement this.
We will have to find it. The Dáil will have to find it. It may not be this year or next year but we are moving along a broad front. In our local authority we fully backed up our demand for health services this year. It will not be up one penny for that reason.
Progress reported; Committee to sit again.
The Dáil adjourned at 5 p.m. until 3 p.m. on Tuesday, March 8th, 1966.