I referred before to the collective responsibility of the Government. "All for one and one for all" is the motto of Fianna Fáil. It is a secret how many boards there will be or what areas will be covered. The only reference in the Minister's statement in introducing the Bill is to the effect that we may have eight boards. We do not know whether that is so or not. We do not know whether Cork city and county will be deemed to be of sufficient size to warrant one board. But my mind moves back now to one of our senior representatives, Deputy MacEntee, when he introduced here in 1960 this unified Health Services Bill which established boards in Cork, Waterford, Limerick and Dublin. We were told then by the Minister that this was their final word on the administration of the health services and the provision of additional services, and that once this Bill became law and that once the health authorities to be established under it got under way everything in regard to health would be settled. Only nine years afterwards another Minister says: "No. Things have not worked out as we thought. We have to change this." We have special sections here wiping out the Cork Health Authority, wiping out the other authorities, and, as I have said five times over in these remarks, giving the Minister and his appointees power to take them over.
Seeing that the Department is paying more than 50 per cent of the cost, I should be quite satisfied if the Minister had a representative or two representatives on a health authority, but surely there is no justification for a Minister saying that because the public funds, through taxation, are bearing more than 50 per cent of the cost he has the right to 50 per cent of the representation? Were it not that this is a move, as I mentioned earlier, to wipe out local democracy and local bodies, the same kind of case could be made for representation on county councils. I thought Fianna Fáil had changed so far as the appointment of non-elected members to boards is concerned. I remember when Deputy Smith as Minister for Agriculture introduced a measure here providing that more than 50 per cent of the members of committees of agriculture should be elected members of councils, but when the Government fell out with the NFA and other farmer groups, Deputy Blaney, the Minister for Agriculture and Fisheries, said in 12 months time: "We made a mistake. What are we going to do? In Deputy Smith's Bill we are giving these fellows who will not have to face the electorate an opportunity of being members of the committees of agriculture" and it was changed overnight. I thought at that time that the emphasis lay on public election, but it is quite evident that, so far as the administration of Fianna Fáil is concerned, expediency is the main motive behind every move.
I should like to ask a few questions. The choice of doctor is one of the items on the credit side of the Bill, an item that could be introduced without any Bill at all, by means of short amending legislation. I should like an explanation of this statement by the Minister at column 1637, volume 239, of the Official Report of 16th April, 1969:
An eligible person would, subject to certain restrictions—mainly as to distance—be allowed to register with any participating doctor willing to accept him and would be allowed to transfer to another doctor after giving proper notice;
Persons could be assigned to a participating doctor where this was necessary;
There would be control on entry by doctors into the service.
If a person, say, living in a village wants to register with a doctor in a town 15 miles away is he allowed to do so? The Bill does not say so. The Minister says he is likely to make regulations restricting such a person from availing of this service because, according to the Minister's opening statement, the main hindrance is as to distance. As regards the control of entry of doctors into the service, supposing four doctors are operating in a particular town at the present time, is there a likelihood that if all four opted to enter the service all four would not be accepted? If that likelihood exists, then to my mind there is not a choice of doctor; in fact, according to this measure, a person could be assigned a particular doctor. I should like the Minister to define what he means by this paragraph I have just quoted.
As regards the charges for services, under section 15 of the present measure any middle income group person entering hospital for treatment knows that the maximum daily charge is 10/- per day. Under this Bill there is no charge spelled out. This is to be done by regulation. I do not think it is right of the Minister to take that power unto himself. He should state specifically whether or not he thinks the 10/- rate is obsolete, whether or not he will have a rigid means test, whether or not he will send assistance officers to families in the middle income group inquiring about the number of cows, hens, or anything else they may have. Is that the system he proposes under this measure? It is not a system that commends itself to me. Indeed, I believe the present system under which everyone knows what the inclusive maximum charge is per day is the better system.
I think the Minister has his eye on the voluntary hospitals. I believe he has it in mind to bring them to heel a little. The voluntary hospitals depend largely on public funds. Most of their patients are paid for out of public funds. These hospitals have played a very important role down through the years. Their services generally are well up to standard. Many of those staffed by religious have given outstanding service to the community. I should not like to see their freedom of action taken from them. I do not believe there is any general demand for that. If the Minister interferes in the management and administration of these voluntary hospitals the likelihood is that he will worsen the position instead of improving it.
So far as district hospitals are concerned, they are catering mainly for the aged chronically ill. I am not at all satisfied with the system under which they operate. Admissions and discharges are more or less the gift of the doctor or matron for the time being. Though the hospitals are maintained from public funds they are administered in a private sort of way and the result is that some people are admitted and others wait for years. Still others are never admitted at all. The system should be examined. Most of the cases in these district hospitals would be social cases. They are there because of lack of means. The only additional income available to them would be home assistance. I think it is very unfair—I have been hammering this home in the Cork Health Authority for years—that the only financial help available to people in the winter of their lives, after a lifetime of service and hard work, should be home assistance. I do not reflect on home assistance, but there is a stigma attached to it. Because of that stigma many refuse to accept it. Surely these people could be paid a disablement allowance? Whether the allowance comes from rates or taxation, or partly from both, is of no consequence; no one would object to such an allowance being given to these incapacitated people.
The treatment of mental ill-health is of paramount importance. Clinics staffed by competent psychiatrists should be provided. There should be domiciliary treatment, if possible; anything that will keep people out of institutions is to be commended. There was domiciliary treatment for tuberculosis patients and it was very successful. Some people object, of course, to attending clinics because they do not want the neighbours to know but, by and large, the numbers attending at clinics are increasing. Any mentally disturbed person should have treatment. Clinics should be established and patients should be encouraged to attend them. If some refuse to attend some other method of treating them should be devised.
So far as the larger mental hospitals are concerned there is urgent need for elimination of the big wards holding 70 or 80 patients. There is no justification for wards of that size. There should be wards holding not more than 10 or 11 patients. That will necessitate more staff and more supervision, but the provision of such staff should not be beyond our competence.
I am pleased to note that some improvements are being effected in that direction in Our Lady's Hospital in Cork. I have been a member of the committee there for more than 20 years and I know every nook and corner in the building. I am fighting all the time against large wards. If people were to see so many housed in such a congested fashion, it would be enough to create a disturbance in their minds. I am asking here, then, that particular attention be paid so far as our mental institutions are concerned to the partitioning of wards, to reducing their size. It is completely inappropriate to have wards holding 40, 50, 60 and more patients.
I have examined closely the advantages of small institutions with particular reference to the hospital known as Saint Ann's, Shanakiel, Cork. That hospital, with a complement of some 120 beds, was opened to the public some three or four years ago. It is one of the most modern psychiatric units in this or, indeed, in any country, I would say. It has a number of private wards for special cases. The general wards are usually small and the complement of patients in most of them is small. Everything is laid out in an exceptional manner. Undoubtedly, a patient receiving treatment in such an institution has a much greater chance of recovery than one would have in, say, the main old building or in the old mental institutions that still exist. I agree that chronic patients are not suitable to be housed in such mental hospitals. Smaller institutions such as Shanakiel, with sitting-rooms and restrooms which compare favourably with similar rooms in any modern hospitals, represent a great step forward and undoubtedly, taking Cork Health Authority hospitals into comparison— Our Lady's and St. Ann's—the difference is vast. It ranges from the low end of the scale, so far as some of the old buildings in the main part of the hospital are concerned, to the lavish surroundings of the recentlyerected modern unit there.
I am all in favour of providing small units where it is deemed necessary to establish mental homes in the future. However, with all the medical advice that is available to the Minister and with all the advances that are claimed in the field of mental illness, one would anticipate a reduction in the number of people requiring psychiatric treatment but, unfortunately, that does not seem to be the case. One would think, also, remembering another phrase of Deputy P.J. Burke about our affluent society, that if, as he states, we are much more affluent now than we were in the past, that should ease tension and possibly result in a reduction in the number of persons requiring institutional care for mental illness.
I am sorry for prolonging the debate but even though I said at the outset that there was nothing in the Bill I think it is right that Members should address themselves to all aspects of the health services. Even though some may deem it unnecessary to speak at length, each member of the House is entitled, in discussing this measure, to address himself to all aspects of the health services.
The problem of mentally handicapped children was an exceptionally heavy problem in Ireland in the not too distant past and to some extent is so today. I appreciate the problems confronting parents in County Cork who have mentally handicapped children and the great burden they have had to bear in caring and nursing such children and in endeavouring to provide some type of education for them. I appreciate the many fruitless calls they make on various people for help in getting institutional care for these unfortunate children. Such care was available only in a very limited way. But, in recent years, thanks to the Polio Association in County Cork, and to the very active committee in charge of it and, indeed, to the very active secretary of the committee, Mr. Bermingham, great strides have been made in the provision of accommodation for mentally handicapped children in Cork city and county. The advances made are far in excess of what would have been made if the problem were left to the Department of Health or, indeed, to local authorities to deal with. Great relief has been given to parents by their children being taken to homes in the city and cared for in an excellent way and trained, in so far as it is possible to train them. The work of that organisation for the care of mentally handicapped children cannot be over-emphasised. The association deserve any support or help that can be given to them from central or, indeed, local funds. I have particular regard for the very capable chairman of the association, Canon Bastible, as well as for the secretary, whom I have already mentioned. Canon Bastible was one of the main movers in this worthy enterprise for the provision of accommodation for the mentally handicapped.
I want information from the Minister as to why he has left home assistance with the local authorities. Is it only because local home assistance is a local charge and the Minister does not make any contribution? However, I am doubtful if this is a wise move because our allowances, or the allowances that would be payable, say, by a health board, are in many instances supplemented by a home assistance allowance. That being the case, I think that one body, irrespective of which body it is, should manage or control both allowances. It is quite evident, of course, that the health board is going to control the disablement allowances. Much as I dislike handing over powers to this type of board which it is proposed to set up, I do not see any great advantage in segregating the administration of both allowances, leaving one with the health board and another with the county councils.
Another service I should like to refer to—I do not wish to hold up the debate much longer—is the availability of blind welfare allowances. Before 1960, when we had separate health authorities in County Cork, all blind people who qualified for the maximum old age pension and who were so certified, automatically qualified for the maximum blind welfare allowance. At that time contributory pensions did not exist. Blind people in West Cork were financially much better off then than their counterparts are today.
When the Cork Health Authority came into existence they changed that system to a more niggardly one. Such applicants were in many instances refused any assistance and in others only small allowances of 10/- or 12/-a week were conceded. Those of our people who are suffering from this great affliction, possibly the worst, should not be dealt with in such a niggardly fashion. Those who were entitled to the blind pension should automatically qualify for the maximum blind welfare allowance without any means test whatsoever. The number involved is not great.
Another matter which will not be affected to any great extent by this measure is the disabled persons' allowance. The opportunity should have been taken here to adopt a more liberal approach to applicants for such allowances. I appreciate it would cost money but, as I have stated again and again, those of our people who are incapacitated are entitled to our consideration.
I have stated already that an exceptionally bad feature of this measure is the power it gives to the Minister and his boys in the public service. It wipes out the powers of the local representatives. It is dictatorial and totalitarian. I do not like that because it will play havoc with the functions of local representatives and with our health services. Henceforth we will be directed by the Department, by people who need not present themselves for election. The public representative is being demoted, downgraded like the county hospitals, as suggested in the hospitals survey book to which I have referred.
It is frightening to think of what may happen under this legislation to people who may have legitimate grievances. They will have no redress. I am damn sure that if any of them calls on the chief executive officer of the health board he will not be seen because these executive officers will not be available to talk to individual applicants even during working hours. Public representatives were glad and willing to see them even after hours.
I am fearful about some of the proposals in this hospital survey book. I do not see much danger of some of the outlandish suggestions in it being implemented but we must appreciate the power the Minister is being given under this Bill and the composition of the health boards. Therefore I call on those interested in retaining county hospitals throughout the country to make their voices heard if they want to keep those hospitals. In view of what is in the Bill, in view of the Minister's pronouncement on 14th December last about hospitals such as those at Bantry and Mallow and those mentioned by Deputy O'Hara, there is grave danger that those hospitals will be downgraded.
This measure casts aside the people and implies that it is only the bureaucrats who know what is good for them. The proposed new system bears a close resemblance to that which obtains in Eastern European countries where the State directs the citizens and where the citizens' views are not taken into account. This Bill seeks to implement a similar system here.
I said in my opening remarks that this is a measure which would qualify for introduction in many East European countries which I have visited and where the citizen is cut out. Therefore I wish to repeat and to emphasise the statement I made at the outset that this is a move to wipe out local representatives. It is a dishonest move in that direction and if it succeeds it is reasonable to assume that in the not too distant future the system of local representation which has served our country and our people so well will be abolished altogether.
They are the only comments I have to make on this measure. Of course, everybody agrees there should be choice of doctor. It did not take a Bill of 40 pages to tell us that—this kind of wanton waste of words and phrases, superfluous in every respect. When, in the name of heaven, will we bring Bills into Parliament in simplified language? A person who wishes to obtain this Bill must send three shillings to the Government Publications Sale Office in order to find out what he is entitled to. Where will he find it in the Bill? We are following the old British system in the way in which we present and draw up measures here. In some cases this has helped some of our brethren in the legal profession because, in order to clarify questions that have arisen on sections or subsections of Acts, we have had to go to these learned gentlemen and sometimes through them to the courts.
I do not propose to support this Bill and I have given a number of reasons why it should not be supported. I am in agreement with the abolition of the dispensary system, which we have had for too long. It led to too much discrimination and many who had to avail of the system were not getting the service they should have got. So far as other matters in the Bill are concerned they could easily have been brought in by way of regulation. We were led to believe that an allembracing Health Bill would be introduced. I need not detain the House dealing with the Cork Regional Hospital for which no sod has yet been turned and will not be turned for some time. I have made my views on that position clear a number of times. Possibly this Bill has been brought in as an election measure. People were anticipating health legislation and the Minister expects that all that they will take cognisance of is that there is new health legislation and it is supposed to be of marked advantage to them and that may help Fianna Fáil over the election hurdle which confronts them.
It would be quite easy to describe this Bill in the words used for the title of one of Shakespeare's plays: "Much Ado About Nothing" but the trouble is that it would not be an apt description. The main feature of the Bill is that it is taking from the local representatives power and giving it to the Minister and to the bureaucrats in the administration of the health services. That is a big feature in this Bill and I hope there will be protests about it. I hope that everybody who is anxious to keep open hospitals in local centres will protest. I did not refer very much to Bantry Hospital because I expected that it would not be downgraded and that no hospital board or authority would allow that to happen, but under this Bill it can happen as it can happen in Mallow and in the other nine or ten centres mentioned in this Bill. It is about time that local people, particularly those not having the Fianna Fáil label, told Fianna Fáil what they think of this Bill so far as it relates to administration. I hope that at the next election the people will bear these facts in mind, whether the election comes in May, June, October or April, and that as a result of all the accumulated effects of such blunders the Minister will not be on that side of the House to propose any further legislation. However, I hope at least the Minister will be here, if he is fortunate enough to escape the electorate.