Dáil Éireann díospóireacht -
Thursday, 1 May 1969

Vol. 240 No. 3

Health Bill, 1969: Second Stage (Resumed).

Debate resumed on the following amendment:

To delete all words after "That" and substitute "Dáil Éireann refuses to give a Second Reading to the Bill on the grounds that:

(a) it fails to provide a comprehensive health service available to everybody based upon insurance principles;

(b) it retains the injustice of financing half of the cost of health services out of local rates; and

(c) it gives, at the expense of local authorities and hospital administrators, excessive powers to central government.—(Deputy Ryan.)

Mr. Barry

When the debate was adjourned, I was appealing to the Minister and his Department to tackle the urgent problem of mentally retarded children. I pointed out, and I hope I impressed upon him, if impressing was necessary, the urgent need for improvement in this matter which, irrespective of money or where it will come from, should be tackled immediately.

I should like to put on record my personal appreciation of the different voluntary bodies up and down the country who do so much work in this field. These bodies and religious orders have shown dedication to this work and their dedication should be put on the record of the House whenever we discuss health problems. I have in mind in particular the remarkable work done by the Brothers of Charity in Glanmire not only by way of treatment for retarded children but by way of consolation for their heartbroken parents. Not only have they been catering for children in Cork but also those from outside its borders.

We should commit ourselves here to giving these people the financial assistance necessary to sustain their efforts in this field. I do not know if the Department of Health make any grant towards the work of the Order to which I have referred. They are described as a voluntary body and it is a pity that we are not contributing by deed as well as by word. They know we are behind them in the commendable job they are doing. The Minister realises as well as I do the tragedy of having these children on a waiting list between the important years of three and six. This could be disastrous to their future possible rehabilitation.

In the explanatory memorandum to the Bill, the Minister states that the objects of this Bill are to provide for a number of improvements and extensions in the health services, to establish a new administrative system for the services and to consolidate the law. Frankly, I do not find in the Bill much indication of where these major improvements are to be made. In this field of looking after mentally retarded children, if I did not do anything else in Dáil Éireann but make this special plea, I should be quite happy. We should make it perfectly clear that no matter where the finances come from, we will assist the organisations who are doing excellent work in this sphere of health.

Having said that, I should like to go a stage further and to refer to the new policy in regard to our mental institutions throughout the country. I am delighted to see in the Bill that there is, so to speak, an open door policy. The medical people in charge of those institutions are to be commended for having done away with the prison walls, the locks and keys. I am delighted to see a situation in which the female inmates of those institutions can go to a hairdressing saloon for a hair-do as well as in Grafton Street. It is an indication of a new and correct approach to the problems of those unfortunate people that prison walls have gone and locks and keys do not jangle. We have begun to realise that this is but another illness. There was a time when it was regarded as a disease that should not be mentioned at all.

The most significant part of the treatment in this field is rehabilitation —the work that those people are asked to do as part of our society. Their contribution, their work, small though it may be, reflects the new outlook. I would ask the Minister, no matter what he does by way of health legislation, to appeal to the officers of his Department to tackle two problems urgently—that of mentally retarded children and the people who have to live in mental instituations.

I referred already to what I believe is a wrong approach: regionalisation of the health boards and, indeed, of the hospitals. Would the Minister now tell me, because this is agitating many of my constituents, on what date he will come to meet the people of the Cork Health Authority to discuss the downgrading of Mallow County Hospital?

Mr. S. Flanagan

As soon as I can. I have no date fixed.

Mr. Barry

I am not being awkward but the Minister told Deputy Cronin and me that it would be after Easter. Easter has gone.

Mr. James Tully

Ten years before it will be interfered with.

Mr. Barry

In fairness to the Minister I think he is serious about this. Will it be within the next three weeks?

Mr. S. Flanagan

At the moment I would need to divide myself in four. It will be within the next three weeks.

Mr. Dowling

I should like to add my voice to that of other Members in welcoming this Bill and the provision for additional services contained in it. Additional services will need additional finances and the provision of finances would seem to be a matter which was given fairly comprehensive consideration by the Opposition Parties. The change in attitude in relation to the financing of the health services as outlined by some of their speakers in the Dáil is an indication that they have moved away from the promises and from the suggestions made in local councils recently. The Leader of the Labour Party clearly indicated his Party's views in relation to the financing of the services and the financing of additional services. He clearly indicated that contributions from the Exchequer, from rates, and contributions from personnel would seem to be the satisfactory way to meet the service. This is altogether different from the suggestions that were made elsewhere recently in relation to medical services by other members of his Party, some of whom are Members of the Dáil. I am glad that the problem can be tackled in a realistic way, knowing exactly where we are going now that we have this pronouncement from the Labour Party in relation to their policy.

I should like to mention a few items in relation to the cost of medical services to local health authorities. Every endeavour should be made by health authorities and by the Department to seal off the many loopholes that exist in relation to the distribution of drugs and medicines to people who are not entitled to them, in relation to the subsidisation of insurance companies by the health authorities at the expense of the ratepayers and taxpayers. I believe it is fairly common that people who meet with serious accidents on the street and are hospitalised for considerable periods of six, eight or 12 months in health authority hospitals are paid for by the health authority. Many solicitors handling such cases fail to claim and to reimburse the health authority the amount incurred. The sums are fairly considerable because these are generally serious accidents and there are many of them that involve long-term hospitalisation. This is a matter that should be followed up to ensure that the ratepayers and taxpayers do not subsidise insurance companies and that the insurance companies meet their responsibilities in full by reimbursing the health authorities and the hospitals for the services provided.

Mr. Ryan

I do not like to interrupt the Deputy but perhaps he is not aware that the law does not permit people in such cases to recover the cost and reimburse the health authority. There are two sections in the 1961 Act and the 1933 Act, both of which were repealed in the 1968 Act which is unfortunate, but the law does not permit courts to award damages in such cases to reimburse the health authorities. It is a pity but that is the law at the moment.

Mr. Dowling

I understand that in many cases costs have been paid to the health authority in respect of accident cases.

Mr. Ryan

Only if a person is a non-Health Act case can they recover hospital charges. If they are blue card cases they can recover nothing for hospitalisation and if they are under £1,200 the most that can be recovered is 10s a day to the health authority.

Mr. Dowling

If that is a fact it is a serious situation and I would ask the Minister to examine the situation to ensure that insurance companies meet their liabilities to the full and that the health authorities and hospitals get compensation from the source from which they are entitled to get it and that is from the insurance companies. There are many factors in relation to charges and services provided by health authorities and hospitals that should be recovered from other sources. The loopholes that exist should be examined. Every little will help in providing additional services.

Medical services cannot be provided unless the money is forthcoming and I would condemn any authority or any group of individuals who would try to deprive any section of the community of what they are justly entitled to under the Health Act. The situation that developed recently in Dublin city and elsewhere is a clear example of the weaker sections of the community who are entitled to the services being held up to ransom by groups of people for their own political ends. The services should be provided and must be paid for and should be paid for. I want to condemn any group of individuals, politicians or otherwise, who would try to deprive the weaker section of the community of these services. I am sorry to say that this has happened in our capital city recently.

Mr. James Tully

We never heard a word about it.

Mr. Dowling

It would be a deplorable situation if people who were in need of drugs or of some medical service were allowed to die or their condition allowed to worsen because people did not measure up to their full responsibilities.

An Leas-Cheann Comhairle

I hope that the Deputy will come now to the Bill before the House.

Mr. Dowling

I have made the point that health services must be provided and when the financing of the services is the responsibility of local authorities the responsible authorities should carry out their duty in full and make sure that the weaker sections of the community are not held up to ransom.

Many additional services are provided in this Bill which I and many others would like to welcome. The home help service operated by the Dublin Health Authority is very effective. It ensures that elderly people get assistance in their own homes, and it relieves the responsibility of people who are unable to deal with the situation adequately—people who are endeavouring to keep elderly people at home and provide for them. I welcome the development of this home help service. Whatever additional cost is involved will be met readily by the community by way of additional taxation, or by whatever method it is raised. I would be prepared to support in any way the development of this service.

The abolition of certain charges was generally welcomed by all speakers as, indeed, was the question of the income assessment for medical cards. These are factors to which the Minister has given detailed attention over a few years and now that he has introduced this Bill, I am glad to see the necessary provision for the rectification of that situation.

The development in relation to child health is a very important one and possibly the most important one. Children's health is most important. We want to ensure that they will not contract illnesses or conditions which would affect them gravely in later life. If greater emphasis is placed on the child health service, we will be doing a great service to the community. The situation which existed before in relation to the servicing of the child health service and in relation to examinations at schools was somewhat farcical. I am glad to see that it is being rectified. There, again, the Minister has his finger on the public pulse. This will give some relief to all sections, because all sections are covered in some way in relation to school children.

Persons who are in need of drugs or medicines on a long-term basis are also being catered for. This extension is one that must be, and has been, welcomed by all sections. I am glad to note that no longer will people who are in need of drugs on a long-term basis have to go around from official to official, week in and week out, to obtain a supply of drugs over the period of their illness. Up to now short-term supplies were sometimes made available by one official and, if he was not available, the person had to buy drugs for a period. Possibly the return of the other official meant that the drugs were supplied. That was a very haphazard way of dealing with the situation. I am glad that matter has been rectified.

On the question of drugs for people who are abusers of drugs, this is a matter which should receive very special attention from the Department, the health authorities, and the people responsible for the maintenance of drugs. For some time the security measures in chemist shops and elsewhere—and, indeed, in the health authorities until the withdrawal of certain types of drugs—were really only an invitation to persons who are abusers of drugs.

I am aware of the contribution in this respect which Deputy Ryan has made to the health authority, and of his interest in the question of drug addicts. I know what horror and concern they cause to their families. As I say, I am aware of Deputy Ryan's contribution and, if he needs support, I am behind him in this matter. Much greater emphasis should be placed on this in schools. Possibly the Department could have some instruction given in schools on the abuses and the horrors of drugs. It has been mentioned to the health authority that drugs are made readily available in some schools to children of a tender age. They are probably taken by the children without any knowledge of the harm they can do, and the destruction they can cause even to human life itself.

I should also like to pay a special tribute to the voluntary organisations who have provided a very effective and efficient service in this city and throughout the country. No words of mine could adequately convey to the Minister or to the House my appreciation of the great work they have done, particularly in the area which I represent, where possibly the most effective and efficient organisation exists which provides meals on wheels and various other services, and endeavours to keep people in their own homes to ensure that the health authority can provide beds for other and more pressing patients. If further assistance is necessary I would ask the Minister to consider increasing the assistance they are given in order to ensure the development of this voluntary effort.

Voluntary effort can and must be developed to a greater degree. We see wonderful examples in some areas but there are other areas in which there are no voluntary organisations in existence and no voluntary effort. This voluntary effort should be encouraged. Possibly the Department should make some effort to encourage local groups to organise voluntary organisations in areas where they are needed. This is a worthwhile development and one that gives relief to people in their old age.

I should like to say a special word about the nursing service. We can feel proud of our nursing service. We have a scarcity problem which hampers some of our hospitals. If the conditions and other factors which are necessary in order to attract nursing staff here are made available. I am quite sure that many nurses who were trained here or abroad would be only too happy to come back to serve at home. There are some defects in relation to nurses' homes and facilities for nurses which make them unattractive to these young women who spent a considerable time in training and who are offering a very valuable service to the community. I know the Minister has a very special interest in their welfare, but there are laxities in various places which could be corrected in a short time at a very small cost and this would make their position more attractive.

As I said earlier, whatever services are provided must be paid for. There is no use in asking the Minister to provide services and then not provide the money. In time to come when this Bill is implemented in full it will give a large measure of relief to various sections of the community that have been neglected up to now to some degree. I want to welcome it as a step forward. I am quite sure the Minister will endeavour to implement all these plans which give a free choice of doctor and the other services I have mentioned. For my part I shall support any Financial Resolution in order to ensure that the weaker sections of the community get the services that are outlined in this Bill.

Mr. L. Belton

This Health Bill falls very short of what was promised. Despite all the grand talk and all the ballyhoo and White Papers we had prior to the introduction of the Bill, the basic thinking behind it remains practically the same. It is still based on the poor law system of Queen Victoria. The cost of the 1953 Health Act is entirely out of proportion to the benefits people get from it. In 1953 it was said—and I think it bears repetition—that the health services were to cost not more than 2s in the £ on the rates. We are all aware of what happened recently in Dublin Corporation when the members of that body protested and voted against increased charges. Last night here, when Deputy Dowling raised this matter on the Adjournment, the Minister, Deputy Boland, in replying to him, admitted that as early as 1956, when Deputy O'Higgins was Minister for Health, members of Dublin Corporation protested and protested vigorously against the charges under the Health Act. Surely in 1956 the cost of the Health Act was not anything like what it is now? The Fianna Fáil Party then thought it fit as members of the Dublin Corporation to protest vigorously against those charges, and according to the Minister, Deputy Boland, the only difference between the position then and now was that Deputy Bob Briscoe, who was then chairman of the finance committee, moved the adoption of the rate. He did everything else that the Corporation did this year except that he moved the adoption of the rate. Surely it is not so terrible that Dublin Corporation went that little bit further, having regard to the amount of the increase in the charges?

Let it be known that Dublin Corporation were not abolished for refusing to strike a rate. They were abolished because they wanted the Fianna Fáil Government to carry out their promise of 1965-66 that health charges would no longer call for an increase in the rates. The Minister, Deputy Boland, no later than today said that, if the members of Dublin Corporation believed that there was to be no increase, then they were foolish and he could not understand why they should believe such a thing because no such undertaking was given. However, it was not only the members of Fine Gael and Labour in the Dublin Corporation who believed this. The Fianna Fáil members also believed it and they taunted the other members——

An Leas-Cheann Comhairle

We cannot discuss the Dublin Corporation on this measure. The Deputy must keep to the matter before the House.

Mr. L. Belton

Surely the increase in the health charges and the fact that Dublin Corporation were abolished because they refused to accept the health charges is relevant? Surely this form of protest was necessary to bring to the notice of the Government that the ratepayers of this city would not stand for any further increases? If this effort fails I do not know what will have to be done to awaken the Government to the fact that the people are no longer willing to accept these extra charges. Apparently nothing short of doing what has been done in other countries as a form of protest, such as somebody publicly burning himself, will draw the attention of the Government to the problem. I do not know how Richie Ryan feels after hearing Deputy Dowling's complimentary remarks towards him here this afternoon.

Mr. James Tully

He is examining his conscience.

Mr. L. Belton

I do not know whether he should examine his conscience or welcome this change of attitude on the part of Deputy Dowling. Maybe it is a good sign that at least the two Deputies who seemed to be most divided here are now recognising that both of them have qualities which are to be admired, and probably Deputy Ryan will return the compliment.

Mr. James Tully

That is what he is examining his conscience about.

Mr. S. Flanagan

It is most unlikely.

Mr. L. Belton

I particularly welcome the announcement by the Minister in regard to applications for medical cards, that the earnings of a son or daughter will no longer be taken into account. I have had the experience—I am sure this has been the experience of other Deputies too, particularly in Dublin—of cases in which a medical card has not been granted because, though the parents were not earning very much, a son living at home happened to be in a very good job. Actually that son may be saving to get married or he may not give up very much at home; nevertheless his earnings are taken into account and, because they are, the parents are deprived of a medical card. I compliment the Minister on the change he has made in that connection.

If this Bill was designed to improve the medical services all I can say is that it falls very far short of the intention which inspired it. The Minister should bring to the notice of the people as a whole the fact that health services are available to school-going children. The situation has been that, if a child is examined and no defect is found but the child subsequently falls ill, the parents are under the impression that they cannot avail of the school health services. It is only recently the principal of a school told me that parents can avail of these services provided they get the principal to vouch for them. The Minister should do everything in his power to inform the public in general that these services are available.

I am glad attention is being given to the provision of assistance to enable old people to be kept at home rather than put them into some hospital or institution. Like other speakers, I commend the work done in this respect by the many voluntary organisations and I hope the Minister will co-operate with these organisations and give them all the help he can. I am sure he is a very reasonable man and he will do everything in his power to help. If these old people are kept in their own homes there will be a saving, to say nothing of their being much happier looked after in their own homes instead of being put away in an institution.

Mr. L'Estrange

I agree with the amendment proposed by Deputy Richie Ryan. Because of the long number of years people have been waiting, hopes have grown higher and higher. However, as one speaker said, the mountain went into labour for four or five years and produced a very tiny mouse. In his opening remarks the Minister said:

I make no apology because it does not contain any spectacular proposals on the extension of eligibility for services.

That is an admission from the Minister that the Bill does not contain that for which people hoped and that which they needed, the things they were led to expect as a result of speeches by successive Fianna Fáil Ministers for Health over the last few years.

For many years we have been arguing here about choice of doctor. What percentage of the people does the Minister envisage will be covered under his scheme? The scheme may work reasonably well in the cities and larger towns but in the rural areas— I am sure the Minister is aware of this —there is a shortage of doctors at the moment and doctors will not attend certain patients. They must attend those with medical cards. Now we believe that all the children of the nation should be cherished equally, yet there is a section of our community in which the people are not entitled to medical cards and a doctor, therefore, need not attend them. Some of us know of cases in which doctors have refused to attend such patients. That is not right. It is unfair because these people pay rates and taxes to provide a service for others, a service to which they themselves are not entitled. A Deputy told me the other day of a doctor who refused to attend a patient because he had not got a medical card. Things like that happen and something must be done to remedy that situation.

More help should be given to voluntary organisations who devote their time and their energy to helping the afflicted and the affected in our community. I know one such organisation in the town of Longford. These people have built a school for mentally-handicapped children. Now there is some regulation whereby they must have a certain number of mildly handicapped or severely handicapped—I am not sure which—and they have got only something like 17 and, because of that, they get no grant, even though they are bringing in children in private cars from 15 and 20 miles away.

Mr. S. Flanagan

That would be under the Department of Education.

Mr. L'Estrange

Could the Department of Health not give any grants? These people are doing wonderful work for the mentally handicapped and there should be some system of cooperation and co-ordination between the Department of Health and the Department of Education. Otherwise they will have to stay in their own homes. When they are brought into this school and trained, instead of being a burden on themselves and on their parents, many of them can be trained to become useful citizens, useful members of society. Instead of being a drag on their families and on themselves, they can become an asset and help to earn their own living. Instead of being a burden on the State for the duration of their lifetime, they can help to contribute something towards the State.

Mr. S. Flanagan

Unless there are 20 pupils, the Department of Education will not give them a teacher.

Mr. L'Estrange

They have told me they are getting no help of any description from anybody despite the fact that they have been with the Department of Health and with the Department of Education and despite the fact that it is costing them £6,000 to build the school. They were very lucky the people gave them the equipment to train the children, the proper type of seats, things on which to do exercises, and so on, but, so far, they have not succeeded in getting a grant from either the Department of Health or the Department of Education.

Mr. S. Flanagan

Perhaps, the Deputy will give me the particulars?

Mr. L'Estrange

I shall let the Minister have the relevant particulars later. The Minister will realise that, in the majority of counties, we have many complaints at present about the dental services. There are very long delays as regards the school system and there are many difficulties and defects to be ironed out as soon as possible. Whether or not the unsatisfactory position is due to the remuneration offered to dentists, I do not know. However, it is a pity to see the pain that is often inflicted on young children due to the long delays. It would, indeed, be well if that could be ironed out. I suppose the people in every county in the country would be delighted if our dental services were put on a proper footing.

The Minister answered a question here yesterday about unrest among nurses over working hours, wages and conditions. I think he said they will get an increase in the very near future but I think their salaries should be brought up to a proper standard. They are doing important work and they should be properly remunerated for it.

We are all very disappointed as regards the financing of this Bill. In the booklet "The Health Services and their Further Development", laid by the Government before each House of the Oireachtas in January 1966, we read on page 59 that the Government at that time stated:

The Government, having studied this issue, are satisfied that the local rates are not a form of taxation suitable for collecting additional money on this scale. They propose, therefore, that the cost of the further extensions of the services should not be met in any proportion by the local rates. Following this decision, other possible sources of revenue to meet the additional costs are being considered but it seems likely that the general body of central taxation must bear the major part of the burden. Pending further consideration of the methods by which extensions of the health services will be financed in future years, the Government have decided to make arrangements which will ensure that the total cost of the services falling on local rates in respect of the year 1966-67 will not exceed the cost in respect of the year 1965-66.

I remember that year quite will. I remember it was an election year. I remember the comments in the local papers in my county. We were told at county council meetings and even by county managers—although they may have been led astray from the wording of this—to spend what we liked as the extra amount on health would be borne by the taxpayers. The then Minister for Health, the late Deputy Donogh O'Malley, made a speech about that around the same time.

We in Fine Gael have believed for a long time that rates are an inequitable form of taxation and that such an inequitable form of taxation needs to be reformed. We now find that when members of local authorities were faced this year—as every local authority in Ireland was faced—with a huge increased demand under the rates heading, when we asked the Government to do what they then promised, we were threatened with dire consequences. Consider the treatment of members of the corporation here in the city of Dublin who acted according to their conscience and who were prepared to say to a Minister and to a Government: "We do not believe in paying lip-service to the burden the taxpayers are carrying and to the promises you made in the past. We now want to test you to see if you will do what you said you would do in the past and act on what this White Paper stated, namely, that the rates are not a form of taxation suitable for collecting additional money on this scale". Those people dug their heels in and said: "Thus far shall we go and no farther". They believe the present health estimate is necessary to give to the poor and to the people of the city the facilities, the amenities and the treatment— hospitalisation or otherwise—they are entitled to but that it is time for the Government to honour their obligation and to share a greater portion of the burden, as they promised. It is five years since the Government stated they were examining this situation and that they believed the central authority should bear a greater cost.

Because those bodies agreed to do this and to stand together, we now find that they have been abolished. I want to object to this system of financing the health scheme. We believe it will place too great a burden on the already overburdened ratepayers of this city and of this country. This Government were considering this in 1965—over four years ago. Surely we should know the result of their consideration by now? On Wednesday, 19th February, 1969, Deputy Liam Cosgrave asked the following Parliamentary Question, as reported at column 1241 of the Official Report of that date:

To ask the Minister for Health if in view of the substantial projected increase in the estimates for health authorities for the coming financial year he is in a position to say what contribution will be made from the Central Fund to ease this burden.

The Minister replied as follows:

I am not yet in a position to say what contribution additional to the statutory grant at the rate of 50 per cent, will be made from the Central Fund towards the cost of health services in 1969-70. In view of the very substantial increase in estimates of health expenditure, I have asked the health authorities to re-examine their estimates and to try to achieve substantial reductions. The amount of the contribution that can be provided from Central Funds will be determined when details of the reduced estimates are available.

I would put it to the Minister that either he was trying to fool the people at that time or else to throw dust in their eyes. I daresay the Government had their mind made up at that time, knew where they stood, and were not prepared to pay any more than what they had been paying up to that time. Was there any reduction or did any health authority come up with any saving under that heading? We in the health authorities claim that either the Department of Health or the Minister tried to fool the representatives of the different health authorities this year. We received a circular, dated 12th February, 1969, from the Department with the reference "HSG 221" which stated:

The Minister feels that in the health services substantial economies can be found without detriment to the efficiency or availability of the present services. He accordingly asks that each health authority should examine critically their forecast of expenditure for the coming year and that they should endeavour to achieve substantial reductions in their projected expenditure.

He went on to ask that they examine their estimates in respect of the health service and he stated that "officers of this Department will be available for discussion on any matters of difficulty which may arise." All local authorities had increased their estimates but the Minister pointed out that substantial reductions could be made. In our county we asked him to send down officials to point out where the reductions could be made but he refused to send them down, or they were not sent down.

We may take it that this circular, which got great publicity on television on the radio and in the Press, was a political gimmick to pretend to the ratepayers that the Department of Health were trying to do something tangible to help reduce the rates in the different counties. They had not told us where the substantial reductions could be made. We took them at their word and said "If you believe they can be made, then send down officials to tell us where they can be made" because the Minister said, and I repeat it, "officers of this Department will be available for discussion on any matters of difficulty which may arise." A very big difficulty arose with us because we were putting an additional three or four shillings on the backs of the already overburdened ratepayers. We adjourned our estimates meeting for a week and asked for officers to be sent down to enlighten us in regard to where the reductions could be made, but our request was ignored and the rate had to be struck.

In general, in this Bill a democratic approach is lacking. Too many members of the different boards will be appointed by the Minister. Ministers come and go and in many cases, perhaps, the appointments will be made by civil servants.

An Leas-Cheann Comhairle

The appointments will be made by the Minister.

Mr. L'Estrange

The Minister will be responsible for them, I agree. This eroding of democracy, whether it is by Ministers or by bureaucrats, must be and should be resisted, and reversed if at all possible. I have been a member of a local authority for many years and I believe we should be jealous of and guard the powers and rights local authorities have. We have people fighting and marching for civil rights and the local authorities should be very jealous of their rights and not allow any Government to take them from them. Members of local authorities are unpaid servants of the people and they have done their work well down the years. However, they have been hindered in many cases by the bureaucrats and others in the Department of Health because a local authority or a health authority has to get sanction from the Minister for anything costing over £15 or £20, I am not quite sure of the exact figure. That is what we have been told anyway but——

Mr. S. Flanagan

That is not right.

Mr. L'Estrange

I will have it checked by next Tuesday. For anything that is worthwhile we have to make a recommendation and then we are held up for a long time. The Minister knows what happened about the X-ray unit for Athlone. It was held up for a long number of years.

Mr. S. Flanagan

For a good reason. It cost a lot more than £15.

Mr. L'Estrange

That can be argued.

Mr. S. Flanagan

And it was argued for all that length of time.

Mr. L'Estrange

We came to a reasonable and sensible solutions in the end. That is why it is a good idea to have discussions with Ministers or their representatives, to have them at meetings and discuss things around the table. That happened finally but for a number of years before that we were sniping at one another from afar.

Mr. S. Flanagan

I never snipe. Whenever I have anything to say I say it. I have sniping to the Deputy.

Mr. L'Estrange

I would say the Minister would be as good a sniper as ever I was.

Mr. S. Flanagan

The Deputy is a past-master at sniping. His bill is about that long. I do not snipe either in the House or outside of it.

Mr. L'Estrange

What has happened with the NFA and the NAC should be a sufficient warning to the Government not to try a similar approach with health. In regard to guarding the powers of local authorities, we should not give this power to any Minister because Ministers can appoint their pals. I have been a member of the General Council of County Councils and when Deputy T. F. O'Higgins was Minister for Health he asked for a nomination from different organisations. They made their nomination and the man was a Fianna Fáil man and he was appointed. Then there was a change and we had a new Minister for Health and he asked for three names. We said "No, we make a recommendation" and the Minister replied that he would not take our recommendation. These were elected bodies doing voluntary work on behalf of the comumnity. The Minister said that he wanted three names. One of the three happened to be a Fianna Fáil man and he appointed him. What has happened with the present Minister? He has appointed to represent us a man who is not even a member of the Council. I admit he is a distinguished member of this House but he is not a member of the General Council of County Councils. That is a negation of democracy and it is bureaucracy running riot. It can be said that the Minister is appointing some of his own pals. That is the danger. If the Minister has the right to appoint people to those boards they will be dominated by the Minister's own pals, whoever the Minister may be. I am not saying that it would be a Fianna Fáil Minister——

Mr. S. Flanagan

Michael Pat said that this was totalitarian.

Mr. L'Estrange

By all means, as the Department is putting up 50 per cent of the money the Minister should be entitled to appoint members of committees and commissions to help on specific subjects but when it comes to the statutory bodies, a high percentage of the members should be elected by the public directly or indirectly. I also think these bodies should have representatives of the various interested professions.

I disagree with the proposal that the Minister, whoever he may be, whether of this Government or the next, should appoint the chairman and vice-chairman. This is a most reactionary proposal and should be resisted at all costs. We should guard the freedom we have because already there are too many inroads by bureaucracy and we should have no more. The chief executive officer should certainly not be a man with anything like managerial functions; his powers should be derived from the board. In my opinion—I may be wrong—the chief executive officer should be a doctor. I am not certain but I think we are one of the few countries with a peculiar system of administration whereby non-professional people advise professional people on how to administer. The Minister may know more about this than I do but it is a system with which I disagree as I consider it wasteful of time and personnel and, perhaps, one of the principal reasons why we have such a large number of civil servants. I am supposed to stay away from that topic and had better do so. What it amounts to is that we have three or four or five people doing one man's job. It could be done much more speedily and expertly by one person with appropriate professional qualifications.

Mr. James Tully

The Deputy is talking about Dublin Corporation?

Mr. S. Flanagan

Dictatorship?

Mr. L'Estrange

No. I am talking about the chief executive officer and saying that he should be a doctor. It would be as logical to have a layman administering a diocese and being advised by a bishop as to have what is proposed here at present. This is not peculiar to the Department of Health but it is a practice which permeates the whole of central and local administration. You have it in local government, in the Department of Justice, in the Board of Works and many other Departments but I think it is a bad system and one which should be changed. There is an opportunity in this Health Bill to remedy what I consider is a grave defect.

Central control is likely to become much more rigid than it is at present under the Bill. I think this is contrary to paragraph 132 on page 67 of the White Paper which states:

It is thought that the Department should in the future become orientated towards forward planning for health services.

We all know what happens in the different countries, that when requisitions are made in local authorities and they want X-rays or many other things needed by county hospitals the medical officer of health approaches the health consultative body or the county council and gets permission. As a member of a local authority, I believe the health authority hardly ever refuse a reasonable request made by a county medical officer, a county surgeon or county physician or any of the professional people. But we find the request then goes to the Department for sanction and we have to wait six, eight or ten months for non-professional people to come to a decision on whether a professional man who needs equipment immediately will get it or not. That is completely wrong and that practice should be remedied as soon as possible.

I doubt if there is very much in this Bill in regard to the serious drug problem which seems to be becoming progressively worse in this city at present. We know that the problem is serious in Dublin and that clubs are engaged in peddling drugs. Many people believe that parents and the Government are not taking the stand that is required in regard to this problem. This House should appeal to parents, teachers, the clergy and the Government and all interested in the welfare of society to take an active interest in the problem, to help in apprehending pedlars as quickly as possible and to give information to the authorities. I suppose Irish people have a tradition against giving information because of the fact that we had an alien government for 700 years and people did not like to give information because they would be called informers. But a call should go out today in an effort to meet this scourge that if anybody knows of a drug pedlar he should get in touch with the authorities immediately so as to have such people traced and quickly brought to justice.

We have all seen the progress of drug addiction in Britain and we should learn from the mistakes made there. They said in 1962 and 1963, as we said a few years ago, that there was no problem. Now they find they have an enormous problem. Unless we tackle this immediately we shall have an enormous problem in our own case. We have seen the consequences of some of the laws introduced in England to legalise certain drugs. There is a rumour that our Government are contemplating taking similar action. I sincerely hope that rumour is false and that we do not have any similar move here.

Debate adjourned.

The Dáil adjourned at 5 p.m. until 3 p.m. on Tuesday, 6th May, 1969.