Before I reported progress I referred to the injustices of the Spring Budget of 1970 which had the rather peculiar element incorporated in it whereby drugs for human beings were subjected to the increase in turnover tax, which resulted in an increase in drug costs to local authorities. I suggest that in future budgets where taxation is involved consideration should be given to drugs which are necessary for the treatment of human beings. The anomaly in the Budget was that drugs for canaries and budgies and cats and dogs were exempted from taxation while drugs for human beings were not. This increase has also led to an increase in the estimates for rates struck by local authorities. I should very much like the Minister in his reply to the debate to point out the figure which has accumulated as a result of the 2½ per cent going not on the wholesale cost but on the gross cost of drugs, the actual finished cost of drugs to the local authorities. I would ask the Minister what would be the estimated total cost as a result of this increase and to what extent the additional sum of £4,850,000 covers the increase in the cost of drugs to local authorities due to last year's Budget. This is very important information which the Minister should be able to give us in his reply. The additional sum which the Minister is giving to local authorities to offset an increase in the rates is, to put it mildly, totally inadequate. Those private householders who are paying rates year after year and who some years ago complained——
Committee on Finance. - Vote 48: Health (Resumed).
The rates position cannot be discussed completely on the Health Estimate.
The people who are providing the moneys for the public health services through the rates are being insulted by the small additional sum which the Minister is granting to local authorities. The day when we saw an increase of a few pennies going on the rates due to health charges has gone and we now see sums of 10s being put on the rates due to increases in health charges. I am of the opinion —and it will take a lot to sway me from this opinion—that a very large amount of the increase is due to the fact that expensive drugs——
Is the Deputy dealing with the future or the year ending 31st March?
This year.
It is the past year we are dealing with, up to 31st March.
Yes. I am of the opinion that a very big part of the increase in the cost of the health services is due to the increase in the cost of drugs, and I do not think that the Government have tackled this problem in any logical fashion by increasing the cost of drugs in the last Budget, as they have done. We have the Gilbertian situation that dogs and cats can get medicines free of tax through their owners, whereas medicines for human beings are taxable. There may be some justication for giving blanket cover for veterinary medicines but tax-free medicines for dogs and cats and taxable medicines for a baby in a pram is not right. I do not know whether the Government realised they were doing that at the time they brought in the turnover tax, but in future Budgets drugs necessary for human life and human wellbeing should be exempted from tax.
The Minister mentions a sum of £250,000 to meet increases in the maintenance cost of patients in residential homes for mentally handicapped and the cost of providing additional day services. These increases arise in respect of existing homes and also in respect of approximately 100 new places provided during the past year. I would like to know if the Minister and his Department provided these new 100 places or if, once again they were provided by the local authority through the rates. If the Minister did not provide them or did not provide a substantial subsidy towards the cost of providing these 100 new places, then I think it is a bad omen for the Department of Health and a bad outlook for remedying the peculiar position in which our society is finding itself as regards preventive health measures in respect of the mentally handicapped and aged people.
A quarter of a million pounds sounds quite a lot of money but I am sure the Minister is aware of the very long waiting list of people who are mentally handicapped, of children who are mentally handicapped, who require institutional care and who require places in residential homes. I could understand if the local authorities were within a very tight budget in providing only 100 new places in the whole year——
There were other places provided. These were ones that came on to stream earlier than we could have forecast, and there will be 455 more beds next year.
With due respect to the Minister, the figure is still not clear.
I have answered innumerable questions in the Dáil about this. I do not know why the Deputy has to go on asking about it.
The questions which were asked in the Dáil were warranted. The situation in regard to the mentally handicapped is scandalous.
I have answered questions in the Dáil continually.
The Minister may have answered questions which I put to him regarding the provision of drugs for such groups as epileptics, spina bifidas, cerebal spastics and hydrocephalics but nothing has been done. Since I tabled these questions their drugs have gone up in price.
It does not arise on this Supplementary Estimate. The Deputy will hear in the new Estimate that something is being done about it. We are talking about the Supplementary Estimate, not about next year's Estimate.
It arises, as far as I am concerned——
I would ask you, Sir, whether the Deputy may discuss new services that are coming into operation, that have not yet been announced in relation to the coming Estimate.
The Chair has pointed out repeatedly that the House is concerned only with expenditure which was incurred in the year ending 31st March. That is the extent of the Minister's responsibility.
If I cannot refer to something to which the Minister has referred in his speech, then there is not much to which I can refer. I am referring to a Supplementary Estimate in respect of which the Minister says in his speech that over £250,000 will be required to meet increases in maintenance costs of patients in residential homes for the mentally handicapped. If the Minister can refer to that and I cannot refer to it, then there is something wrong.
The Chair is not inhibiting the Deputy at all from referring to matters the Minister has mentioned. What the Chair is saying is that matters that are in the future cannot be discussed on this Supplementary Estimate.
What am I discussing that is in the future? I am discussing what is here. I asked the Minister the number of new beds. He mentioned beds in the future about which I did not even ask him. I asked for the number of beds that were provided in the past year and to which this statement refers. That is what I am referring to. With respect, Sir, I should not be tricked by the Minister into following a red herring in regard to next year's Estimate. I would not do that. I am adhering to this Supplementary Estimate. I have quoted from the Minister's statement and I do not intend to quote it again. However, while £250,000 is being provided to meet increases in maintenance costs, there has been no provision made in budget after budget for the cost of maintaining mentally handicapped patients in residential homes.
There is provision made. This includes any increased costs representing additional rates of capitation for the existing patients in homes for the mentally handicapped, which are run largely by the religious orders, and it also includes the increased capitation grants for the new beds for mentally handicapped.
I am talking about any exemption that would be made in regard to increases in wholesale or turnover tax towards the cost of maintaining these patients and these have not been made. Perhaps a grant is given instead. The situation in relation to residential homes for the mentally handicapped is very bad and the Minister must agree that, if it were not for the help of the clergy and the religious orders, there would be nothing whatsoever done about it.
Why is the Deputy going on about them? I have paid tribute to the religious orders about once every month of this year. Why is the Deputy talking to me about them?
I am merely pointing out that if we had not got these religious orders——
The Deputy is merely repeating what I have been saying.
The increase of 100 new places for the mentally-handicapped is totally inadequate. We are told that an additional sum of £25,000 is required to cover the cost of the intensified health education activities of the Department and those activities aimed at persuading young people not to smoke cigarettes. That is commendable. At last the Minister has taken action in this particular regard although the writing has been on the wall now for about ten years. There is no doubt that cigarette smoking is a large contributing factor to lung cancer and I hope that in the future the measures being taken by the Department will be reflected in the general health and well-being of our children.
However, with reference to the preventive element. I should like to see the Minister going a step further and investigating other substances and compounds that are on sale. In particular, I should like to see him, with the Department of Justice, seriously considering the feasibility of curtailing excessive habitual consumption of alcohol. This must be one of our greatest problems. It is unfortunate that this Supplementary Estimate makes no provision for some form of publicity campaign to make people aware of the dangers inherent in the consumption of alcohol and the molecule which we know as ethymon.
There is supplementary provision to include a sum of more than £400,000 to meet the cost of providing increases in allowances payable to disabled persons. The Minister is probably not in a position to state the number of disabled persons who are drawing disablement benefit but I am sure he is in a position to state the percentage increase they would receive from this sum of money. Not only is there a large section of our people drawing disability benefits but I would also point out to the Minister that there will be an increase in the percentage of the population who will be drawing disability benefit and that this Supplementary Estimate will have to include a figure much higher than £400,000. As medical science advances, the ability to save the lives of the aged, of the infirm and of the premature is increased. As the Minister is probably aware, it is children who are born prematurely who are most likely to suffer from mental deficiencies, from cerebral palsy and epilepsy.
During the past five years the Dublin Health Authority have provided new services and new methods of surgery which result in keeping alive children who were born with spinabifida. About 90 per cent of these children will be kept alive so that all of these will be entitled to disability benefit because they may suffer from paralysis of the legs or, possibly, enlargement of the head and, in many cases, chronic kidney infection. Therefore, I say that while this £400,000 is necessary it is not adequate and I criticise it openly. We have those who are unemployed and those who are unemployable and the sum of £400,000——
The Deputy will appreciate that we are dealing with a Supplementary Estimate for what is past and not with an Estimate for the future.
The sum is £3 million and £400,000 is being added.
What I am trying to point out to the Minister is——
May I ask if we are now starting a debate on the Health Estimate for next year because, if we are, every Member of the House can contribute his share of argument for it? Therefore, we will have two main discussions on the Health Department in the year, one during the Supplementary Estimate and another discussion when the main Estimate is introduced. It would be impossible to get through in parliamentary time, even with all the proposals made by the Fine Gael and Labour Parties for the reform of Parliament, if this were to be the case.
The Chair is concerned with money which will fall to be paid up to the 31st March this year. Anything that would fall to be dealt with after that date is a matter for future Estimates.
Once again I can only hope that I am referring to the Minister's brief which I have before me and in which I read that more than £400,000 is being provided to meet the cost of increased disability allowances. If I cannot discuss that it will be difficult for me to discuss anything. I do not know why the Minister should be afraid to allow me to discuss this. There are some important points that I wish to make—points of which I do not think the Minister can be fully aware.
All the Chair is concerned with at the moment——
The Deputy is confirming the point that has already been made by this side of the House in relation to proposals for the reform of Parliament. All this talk of Parliamentary Committees is just nonsense if this kind of thing is to be carried on.
With all due respect, I do not think the Minister should talk about nonsense when members of his own party have made a mess of the House.
The Chair has pointed out repeatedly during the debate that we are concerned with expenditure which has been incurred or will be incurred up to the 31st March this year. Arguments as to whether these are adequate or otherwise are a matter for a future Estimate.
I was referring to the supplementary provision for £400,000 for disability benefit which is mentioned in the Minister's statement. If the Minister can refer to it, I can refer to it. I am quite sure that the Leas-Cheann Comhairle rules accordingly.
I do not think the Deputy understands. That £400,000 was voted in the Budget of this year and the Deputy had the opportunity of commenting on it not only during the Budget debate but also on the occasion of the debate on the Health Estimate, so he has already had two opportunities to discuss it. It is not an afterthought. It was provided for at the time of the Budget and represents an 11 per cent increase on the original provision.
Then I fail to see why it should be mentioned here. If it is your ruling, a Leas-Cheann Comhairle, that I cannot mention it here, then I will pass from it. I do not see why. I am a new Deputy to this House and apparently the Minister is trying to embarrass me into not contributing on this.
The Chair is not ruling against the Deputy's contribution on expenditure which is provided for in this Supplementary Estimate. The Chair is pointing out that any proposals in regard to future expenditure must be kept for the main Estimate.
I can refer to the £400,000.
The Deputy can comment on the expenditure.
That is all I want to do. I presume I can comment on the £400,000. I do not want to be here next Tuesday trying to finish off what I want to say. I was referring to the utter negligence of the Department of Health in not attempting to make any satisfactory provision for the disabled people in this country over the past year and up to 31st March of this year. No effort whatsoever has been made. That money is totally insufficient. The Minister promised that he would have certain investigations made with a view to alleviating the financial strain incurred by disabled persons. He has not done this. There are many other things I wanted to say but obviously I will have to leave them over and get a clearer ruling on what we are allowed to discuss.
The Chair does not appreciate that comment by the Deputy.
I will consult with you afterwards, a Leas-Cheann Comhairle, because apparently the Minister can discuss something and I cannot.
The Deputy may comment on what is in the Supplementary Estimates but not on omissions from it.
I will pass on from that reluctantly. The £400,000 mentioned in the Supplementary Estimate is totally and utterly inadequate. Many of the 65,000 old people in the city of Dublin area are not getting sufficient in disability benefit. The number of these people is increasing and they are living longer. Therefore this £400,000 is being paid to the new people who enter this group. Their numbers will increase as medical science makes further advances all over the world. I have pointed out to the Minister before that provision should be made to cater for the polarisation——
The Deputy has not done his homework. I told the House during the course of the debates on the Health Act that provision would be made in the new financial year for long-term disabled persons suffering from certain diseases. That promise is being honoured on October 1st. If only the Deputy would do his homework.
With due respect to the Minister he also promised a choice of doctor service on 1st April and that has not come in.
That is subject to negotiation and this is not.
There is nothing for the hydrocephalics or the epileptics.
This is arrant nonsense. I have said that I am honouring my promise. I have said that I am honouring the promise I made during the debates on the Health Act. It does not arise on this Supplementary Estimate. I said I could not do it until the new financial year.
I have criticised the figure of £400,000 as being insufficient. I am entitled to criticise that figure. I am glad that the Minister agrees with me and that he has made provision for the future. I am glad that the numerous contributions made from this side of the House, which were thoroughly researched, have not been ignored by the Minister or his Department.
I should like to refer to one big defect in our health services at local authority level. Part of the increased grants to health authorities should be used to improve the standard of the ambulance services available in the local authority areas. In the Dublin area there are three separate types of ambulance service. There is the cardiac service which is run privately with a grant from the Department of Health. It is an excellent service and one of the most up-to-date in the world, and a doctor is available to it if necessary. With the increase in coronary conditions this is a very important service. The first city in the world to have such a service was Belfast and I believe that Dublin is the second city to have it. We have the maternity flying squad which is also an excellent service provided by the maternity hospitals. The Minister deserves great credit for whatever subsidy he gives towards the provision of these services.
The DFB ambulances have been criticised for some time. Some of that criticism was justified and some was not justified. The time has come for the Minister's Department to take over this specialist function of providing ambulance services throughout the country, and particularly the accident service which is run by the Department of Local Government. Quite recently in the Dublin area out of six DFB accident ambulances four were without sirens because they were worn out. The Minister should investigate the possibility of his Department taking over that service. I also think that a doctor should travel in the accident ambulances. I know that the Stillorgan cardiac ambulance carries a doctor on occasions and the maternity ambulances also. A doctor would be very useful at the scene of an accident and lives might be saved if a doctor travelled with a DFB ambulance. I am aware that the equipment in these and in the resuscitation units which has been brought in by the Department of Local Government has improved the service some-what but it could be improved further by having a qualified medical doctor on board each ambulance. I do not want to quote particular cases but I do know of cases where if medical treatment had been available in the ambulance it could have resulted in the saving of life. I know of a few such occasions and I am not the only one who knows of them.
I do not want to limit myself to the Dublin area where an ambulance arrives at the scene very quickly, where there is a number of excellent accident hospitals and the care given to the coronary and accident patient is excellent. Once or twice I had occasion to call an ambulance in a rural area and it takes quite a length of time. The positioning of these ambulances may not always be the best. If we could arrange for a doctor to travel in the ambulance in country areas it would be a good thing. It would be very timeabsorbing and it would have to be done by a newly-qualified doctor, perhaps as part of his rotating intern year. This would involve a certain amount of new legislation but what is legislation when we are talking in terms of life? Even if ten lives were saved——
Do we advocate new legislation during a Supplementary Estimate, a Leas-Cheann Comhairle?
I would like to see doctors appointed to ambulances to travel with the patients.
There is a provision of £100,000 for the setting up of the new eastern region health board. I am sure the Minister is aware that this is the only health board area in the British Isles where provision is made for two specialists in two general hospitals. The situation in which so much administrative costs——
The Deputy is aware that he may not, at this stage, criticise legislation which has already been dealt with in the House.
The cost of wages, salaries and allowances in the administration of a hospital is very high. This is particularly so in the Dublin area. It is no surprise to me that there is an additional £50,000 required for this. In the Dublin Health Authority area at present there are five children's hospitals, three maternity hospitals, something like 12 teaching hospitals. In the whole area there are 70 to 75 hospital institutions taking in convalescent homes, psychiatric homes and nursing homes. This is one of the greatest wastages of money I know. Each one must have a caretaker, a porter, a secretary. The duplication is fantastic. It is not unusual in the Dublin Health Authority area for a child who has come to the attention of the district medical officer to have visited all five of the children's hospitals. Each time a patient goes into hospital it is estimated that his name alone is printed about 44 times. This gives an idea of the type of bureaucracy that is involved here.
The only part of this £50,000 that is justified is that which has gone towards the nursing profession, towards increasing the number of nurses and raising the standard and the status of nurses. I want to ask you for a ruling here, a Leas-Cheann Comhairle. These increases in the salaries, wages and allowances were unavoidable, the Minister has pointed out. Would I be in order in criticising that word "unavoidable"? Would it have been possible to achieve this in another way? Could the income tax allowance of these people, particularly the married nurses, not have been increased?
The matter of income tax allowances would be a matter for another Minister.
We are now dragging the income tax code into this debate.
I was merely asking for the Leas-Cheann Comhairle's ruling and he has given it.
I am glad the Chair gave the ruling because we could discuss anything on that basis.
The Minister interrupts so much but I was asking for the Leas-Cheann Comhairle's ruling. I would criticise severely the duplication of hospital services in the Dublin area. With rationalisation the figures here would not be so high. In an army if there are so many machine guns there must be so many people behind them. In a hospital where there is X-ray equipment, pathology and operation equipment, there must be the maintenance staff, the administration staff and the professional staff. Dublin is perhaps the area where there is most duplication in the whole of Europe. These increases in grants to health authorities have become necessary due to the fact that the Department of Health for so long were willing to plod on in the old system of health services being financed out of the local authorities and the local authorities being unable to take any big steps in the modernisation of their medical services without incurring great hardship on the population that were contributing to the rates.