Léim ar aghaidh chuig an bpríomhábhar
Gnáthamharc

Dáil Éireann díospóireacht -
Thursday, 9 Mar 1972

Vol. 259 No. 9

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

Debate resumed on the following motion:
"That the Vote be referred back for reconsideration."
(Deputy R. Barry).

When I reported progress I was dealing with the question of handicapped children and the negative approach of the Department to this very important part of our health services. On page 33 of the Minister's statement he says:

While it is hoped that it may be possible in the future to achieve a situation where the majority of the handicapped will be able to live in the community, there will always be a need for lifetime residential care for many of the more severely handicapped for whom such care is unavoidable. For these patients it is my policy to ensure that they will be adequately housed and that they will be given the opportunity of being trained, including training in sheltered workshop activities, to the extent that their disabilities will permit.

This is nothing but another dream of the Minister. What is he doing about these people? He hopes to have them trained in sheltered workshops. Eight years ago we brought the Brothers of Charity to Limerick and gave them 48 acres of land from the Limerick Health Authority. Not a sod has been turned on that ground since then. We have provided a site for sheltered workshops beside the industrial estate. The Minister and his Department can take no credit for providing anything for those people. Those people would get nothing without the pressure which we, as public representatives, and social workers bring to bear on the Department. You could turn the key on the Custom House because they will do nothing unless they are driven to it, and that is my experience dealing with them over 20 years. I do not know how many words or paragraphs are in this document of 50 pages but I should like to quote this:

I would like again to express the country's gratitude to the religious orders and voluntary bodies and the health boards who provide the backbone of these services. Without their active participation we would not have achieved the advances we have made in providing accommodation, care and training for our mentally handicapped.

People who have devoted all their lives and others who have devoted all their spare time trying to do something which the Minister and his Department have neglected to do and which it is their obligation to do, get four lines of appreciation out of a 50-page document. This is typical of the Department of Health. They cannot see the hundreds of people who are going around the cities and large towns every night of the week doing the work which the Department should be doing, visiting the old people, providing meals on wheels and all the other things they are doing; the religious who are out night and day nursing bedridden people, washing them, cooking for them and looking after them generally. With many years experience in public life and with the full realisation of the position I hold locally and nationally I say the Department of Health are the most inept Department we have. They are absolutely inhuman in their approach. There is no provision for family visits to hospitals. You come at 12 and you leave at two. You come back again at four and you are put out again at 5.30, having travelled 100 or maybe more miles in order to visit a patient.

I have dealt with the position of the handicapped children and what is not being done for them, and with the fact that unless we social workers and public representatives continue the work we have been doing for years, the Minister and the Department will do nothing about it. The fifth generation of Irish people will not see half the schemes delineated in this 50-page document. On page 45 there is reference to the National Social Service Council:

That the Council have a challenge is evidenced by the fact that in the whole of the Republic there are 37 Social Service Councils operating reasonably full services and 32 councils mainly caring for the aged.

I want to ask the Minister and his Department what financial assistance are these social service councils getting to carry out the work which they perform. I have related my experience in regard to the handicapped children. The cost of the project is £8,000; we get £2,000 and we have to get £6,000. I am not in close touch with the social service centre in Limerick but I know the tremendous work they are doing. Were it not for the charity of the people of Limerick city and county and the adjoining areas it would be closed long ago. What they get from the Department would not provide the meals on wheels for one season, let alone enable them to do all the other work they are doing. The gem of the Minister's speech appears on page 46:

The population, for the first time in many years, is rising. New industries have been established to replace those becoming obsolete and to provide for the many who are leaving agriculture and seeking alternative employment.

Would the Minister tell me where is this happening? Where are all these industries and the employment being provided? The Minister and the Department are mute of malice. I can understand human nature as well as anyone else, but for an allegedly responsible Department to make such a statement is going too far.

I want to turn the Minister's attention to a few other matters which I think deserve careful consideration, if that is possible in that Department. First of all, there is the question of the issue of medical cards. There is no strict rule of law which can deprive a person of medical care because all cases must be taken on their merits and it is misleading of the Department to deal with this matter in the mixum-gatherum way they have been doing it. It confuses people's minds.

Workers get increases in wages after a hard fight at conciliation and arbitration because of increases in the cost of living. When they applied originally for medical cards they might have had less than half the wages they now receive but these original applications are trumped up in front of them. The cost of living at the date of the original issue of the medical card has no relationship to present-day circumstances but people who had medical cards are being deprived of them. This should not be happening.

Another matter which concerns my area particularly is the establishment of a school of physical education. We welcome it, and its establishment does not give cause for thanking the Department of Health. It was established because of the agitation of the people in Limerick and the surrounding areas. At the moment there are students doing this course in England at second, third and fourth year levels. They will come back when the building in Limerick has been completed and will continue here where they left off. We anticipate 1,000 students on opening day in all grades. My point here is that we should be preparing for this and I suggest that the Department of Health, in conjunction with the Department of Education, should provide for the compulsory physical education of children at primary and post-primary levels. It should be added to the curriculum of those schools.

Is not this a matter for the Department of Education?

With all due respect, physical education concerns the health of our nation and I think it should be included.

The Department of Education are dealing with this and therefore it is their responsibility.

I want to alert those people who are droning and sleeping in the Department of Health——

It is a matter for the Minister, not the officials.

The Minister, unfortunately, is not here.

Give him a break.

I want to deal with dental treatment. We talk about fluoridation of water and the treatment of schoolchildren but that is as far as it goes. I realise that by starting at the bottom we will reach the top eventually, but adults have been waiting years for dentures. I know there is some trouble with the dentists' association. I do not know the facts but if it is anything like the case of the psychiatric nurses I know well where the blame lies.

Finally, I wish to deal with the problem of alcoholism. It is a curable but a recurring disease. The main trouble is to get an alcoholic to admit that he is suffering from it and it is only when the crisis stage arises that he gets treated one way or another in some hospital. It is all very well for those in the opulent bracket who can take expensive treatment at 40 guineas a week plus in private hospitals. They have to get electrical treatment to be dried out and then they can go away to recuperate, but the unfortunate person who cannot do that is dumped in a mental hospital.

Even though they may not be with the other mentally disturbed patients, neverthless they are in the same building. I have been agitating for the last five years for an extension to the Regional Hospital at Limerick so that these people can be treated in a normal atmosphere. Nobody wants to be branded as a person who has a mental disease and even though the patients may not be in the hospital for long periods they are in a depressing atmosphere. I visit these people frequently and I know that they have lost that confidence that is necessary if they are to recover. The depressing environment of the mental hospital does not help but if they were treated in a general hospital they would recover much more quickly.

Recently the Department made a slipshod effort to combat the dangers of excessive drinking. They went around to all the publichouses and distributed some leaflets on this matter. I do not know how much this effort cost, but it was a waste of money because it did not have any impact. Alcoholics Anonymous do a tremendous amount of work about which the public do not know. They meet and discuss their problems and the effects on their families and on themselves. They hold meetings throughout the country and they try to bring people into their organisation. They have private meetings at which they discuss their problems but they also have open meetings which anyone can attend. They do tremendous work and they deserve every consideration. They visit the admissions departments in the mental hospitals and they visit prisons and take to the people in those places. However, the Department do not give them any help.

The Minister mentioned this problem but he does not tell us what he proposes to do to help in the matter. It is my business to know all sections in the community and to know how they live. I know the havoc that alcoholism can bring in domestic and business life. Yet the Department can do nothing more than make the feeble effort of throwing a few leaflets into publichouses. They should realise that a disease is a disease, it is not something to be played with, but this is what the Minister and his Department are doing. It is time they realised their responsibilities.

I want to remind the Minister of a statement made by his predecessor, Mr. MacEntee, regarding students who qualify in this country. He deplored the fact that the majority of them emigrate when they qualify. The students who took the Minister's advice and stayed at home worked to get fellowships and to specialise in their professions. However, when vacancies occured it transpired that those who stayed at home were not even shortlisted for appointments because they did not have experience in other countries. This was tragically brought home to me lately when I heard of a young man who took this advice and stayed at home; in fact, he was the only one of his group who stayed in the country. He continued to work for his fellowship but he will not be appointed until after he has done a two-year course abroad. He is now in his late thirties but he will be forced to take this step before he can apply for a position in Ireland. Is that the way the Department should conduct their business? I could enumerate many cases of ineptitude and a lack of human approach and knowledge by the Department.

The Department should face up to their responsibilities. It is not my job to point out these things to them. They are not doing their job, they do not know how people have to exist. All they know is how to set up health boards—I would call them confusion boards.

I have made my contribution in an effort to be as helpful as possible from the experience I have obtained in my 20 years in public life, during which time I have dealt with health matters for the ordinary people. I have been critical because I have been forced to be so, but I hope that as a result of what I have said today something will be done. If not, I can assure the Minister that the Mid-Western Health Board will hear all about it and from there it will come back to the Department again.

It may be assumed that Deputy Coughlan does not think much of the Estimate. That is his viewpoint and he is entitled to it but, to emphasise how Deputies, like doctors, may differ, I consider this a very fine Estimate not alone because of the programme for the future but also because of the record of the past. Today we spend over £1.5 million a week on health and general health services, quite a large slice of the total national budget. For the first time since the Famine almost, the population is increasing and the birth rate in the last year continued the upward trend evident in the two preceding years. All these things show that at last we are creating a society which has lost its defeatism and despondency and is building on a basis that will ensure that each citizen will have a life expectation as good as that of any other European and that this can be credited at least in part to the excellence of the health services.

I shall not go into a panegyric on the Health Department or any other Department but we must give credit where it is due. I do not always agree with the Minister but he has shown dedication to his task since he entered this Department and this, together with the dedication of the Department themselves, is producing good results and we can expect better results in the future. Deputy Coughlan said the religious orders got very scant praise from the Minister but I have always noticed that the Minister is always at pains to thank the religious orders for their services to the sick and needy. We must remember that in these days of the liberal ethic it is not quite fashionable to praise religious orders and society may well forget that before most of today's liberals were shouting about the rights of the weak and the sick, the religious orders were working without any thought of financial reward and setting the headlines which the liberals are trying to emulate today. The religious orders are still running some of our best, if not the best, institutions and I hope they will continue to do so, irrespective of what form our society will take in future.

If we spend £1.5 million a week this must be found by taxation and people ask if we are getting value for the money because the taxation bears heavily on many of them. Quite a large amount of the total rate of any local authority is made up of health charges and were it not for the action of the Minister this year and in previous years the impact of health on the local rates would be much greater. He and the Government have, by subvention, helped to reduce this impact on families in urban areas particularly.

A cry goes up each year around estimates time that the health charges should be taken off the municipal rate. People do not examine this idea sufficiently carefully: if they did, they would see that while the rates might be lower, total taxation on the individual would be much greater. Some of the large industrialists and really big firms would have the health charge removed from their rate bill. To take one very large firm in the city which must pay a couple of hundred thousand pounds in rates each year, if you took the health charges off that they would save one-third of the huge total but general taxation would have to make up for this. I do not think the health charges should be taken off the rates for that reason, but I agree that many young couples trying to rear families and trying to pay rates on their houses feel this heavy impact on their rates and because they are in a certain category with an income of over £1,600 a year, they are not getting many benefits from the health service. They get benefits but not all the benefits they seek from the health service. That is why I think the Minister each year must go on examining the attitude of the Department of Health towards the total rates bill of which the health charges are such an essential and important part.

The Minister covered all aspects of health but I am particularly interested in the care of handicapped children. I have often seen protests in this city and people lying on the ground stopping traffic but if any section has a real grievance it is the parents of mentally handicapped children who cannot at the moment be given residential accommodation in a hospital or institution. Yet, because of the seriousness of the complaint of their child the child cannot be kept at home although the parents would prefer it that way. This is utterly impossible in some cases. Yet, they must take their place on a long waiting list for entry to an institution.

This is an aspect of our health services with which the Minister has undoubtedly dealt to the best of his ability with the money available and the Department have shown commendable enterprise and advanced thinking on this whole problem, but even at the risk of depriving some other section of facilities that should be theirs, we should, perhaps for one year, concentrate more of our capital and energies on the provision of a full service for these children and on being able to guarantee to parents that when they die their children will be assured of a guarded and protected life, not so much in an institution but in a home unit which would help the children to lead as full a life as possible. If I may mention one of the excellent societies we have here, the Parents and Friends of Mentally Handicapped Children, they are raising funds as best they can, again with Government help, to provide a residential unit with a mother figure or father figure to look after these boys and girls when they become adults and their parents have passed away, so that they will not be thrown out but will have this home in which they will be looked after. If there are some who are able to go to work, it is of great benefit to them to be able to come home to a family-like atmosphere. Great credit is due to such societies as this for the work they are doing in this sphere.

It is heartening to notice that no case of poliomyelitis was notified during the past year. We must express our thanks, too, to the Polio Fellowship of Ireland for the marvellous work they have been doing in providing accommodation and general welfare services for victims of this disease. Although the disease now seems to be almost extinct, there will be the unfortunate victims of past outbreaks to be cared for during their lifetime.

In order to do justice to the Minister's brief, one would need to speak on it for three or four hours, but it would not be fair to detain the House for so long while other speakers are waiting to get in. All I intend doing is commenting briefly on certain aspects of the statement.

The Minister has supplied us with plenty of detail. We are told, in relation to vital statistics, that both the birth rate and marriage rate have increased. This is heartening. I notice that the death rate is at the same level as it has been for the past five years. I note in particular that deaths from all forms of cancer were at about the same level as in 1969. All we can do in this respect is express the hope that this dreadful disease is being checked. However, the number of deaths from lung cancer continue to increase with the figure running at about 50 per cent greater than the 1963 figure. The Minister has launched an anti-smoking campaign and I hope this will be successful in preventing young people, in particular, from acquiring the cigarette smoking habit and will encourage those who are smokers already, to try to give up the habit. I suppose there is little hope of stopping the habit among those of us who have been smoking for a long time. It saddens me to see so many young people smoking. Only the other day I happened to be passing a primary school as the children were coming out and the first thing one of the smallest boys among the group did was to light a cigarette. The participation of well-known figures in the sporting and other fields in the campaign being mounted on television should prove effective. RTE, in refusing cigarette advertising, are playing their part in the campaign. Unfortunately, however, from what I observe in shops, restaurants, and so on, there is no decline in this habit among young people in particular. Of course, statistics could prove me wrong on that.

There was reference in the statement to staff relations in hospitals and in this context there was reference to the strike of psychatric nurses that took place some time ago. There is something very wrong in our society when nurses at a mental hospital would go on strike. I shall not try to lay the blame in any particular place or on any particular side, but I would say that one of the causes of the trouble was that promotion was being claimed by these nurses on a seniority basis. The unions insisted on this, but as a union member I have always understood that seniority was considered only when all other things were equal. Indeed, this was a guideline of trade unionists and I do not know why it was departed from on that occasion.

Despite all our pretensions as to ours being a Christian society and that we spend so much each year on health, we had a situation where the mentally ill were left to care for themselves during part of that strike. All I would do here is to appeal to all concerned to ensure that never again will there be a strike of mental hospital nurses. If there should be a dispute at any time in the future we can only hope that it will be fixed through communication with all sides involved before there could be any question of a withdrawal of services.

Everything possible should be done to avoid a strike where medical services of any nature are involved, but, particularly, where mental health services are concerned. Whether a person be a Minister, a civil servant, a nurse or a public representative, it is up to him to ensure that every effort is made to settle whatever grievances may arise. I condemn neither side but I hope that we shall never again hear of this kind of strike in mental hospitals.

The Minister mentioned improvements in conditions and facilities in general hospitals and institutions for the mentally handicapped. We are building new general hospitals and institutions at a great rate. Since the foundation of the State we have provided a hospital service well up to normal European standards and, in some aspects, far ahead of European standards. The Minister mentioned Sir Patrick Dun's Hospital. I am a member of the board of that hospital. A few weeks ago the Minister opened the new nurses' home there. In this materialistic age it is a good thing to know that we have no shortage of girls entering the nursing profession. That being so, we have no right to impose on their idealism and their dedication by asking them to work in substandard conditions.

Some of our hospitals are very old. We go on patching them up and spending thousands in the process every year. We should be pulling them down. I know the Minister has planned their replacement by new buildings. These, of course, will take both time and money, but it will be a good investment and no one will quibble at the incidence of taxation for such a worthy purpose. I agree with the Minister's action in amalgamating certain hospitals and may I pay tribute here to the federated hospitals for their unselfishness in submerging their identity? When this scheme reaches completion we hope to have the most modern hospitals possible. Dublin has a great history as a medical centre and we must preserve this at all costs. I am sure the Minister's policy will ensure this.

The Minister dealt extensively with psychiatric services. The Commission on Mental Illness were concerned about the high number of in-patients. The latest figure for 3rd December last, is something over 15,000. This represents a reduction of over 3,000. It should be our ambition to keep people out of hospital. There are many small ailments which could be dealt with in the home. With improved housing the majority of houses now have running hot water. A team of doctors working around the city could perform minor operations in homes. That would result in less dislocation of the domestic scene when, for instance, a mother is removed to hospital. This is not new. Maternity hospital do this all the time. An extension of that kind of service would be an excellent idea. A team of doctors and surgeons could work in clinics in built-up areas like Ballyfermot, Ballymun, Raheny and so forth. Some of these satellites are bigger than some of our provincial cities. This service would keep people out of hospital and reduce the cost of hospitalisation generally. This is done in other countries. As I said, it is done here on a limited scale. It should be extended.

A very serious problem is that of alcoholism. It is impossible to say how many alcoholics we have. Unfortunately, alcoholics is increasing. The drug problem is a small problem compared with that of alcoholism. Recently I came across a case in which a boy of 11 years was involved. His father thought he was drinking. He brought him to the teacher to discuss the matter with him and it then turned out that the boy was not drinking but that his two pals of 11 and 12 years respectively were drinking; they bought cider and other drinks and got drunk on them. Unless these receive treatment now they will become alcoholics. Parents try to rear their children properly but a parent cannot keep a rein on a boy all the time. He cannot stop him going to these shops in which he can buy these beverages that make him drunk. The case I mentioned proves that.

It is so easy to go into a shop and buy a type of cider or of wine on which these boys can get drunk. I do not blame the boys. They are probably doing it out of bravado. I do blame our set-up which allows drink to be sold to boys of 11 years of age. The parents, in this case anyway, were doing their job as best they could. This can happen in any family. I hope the Minister in his battle against alcoholism will lay emphasis on the prevention of the sale of drink to young people. I do not include the proprietors of licensed premises in this because they obviously will not sell drink to a boy of 11 or 12. I am referring to the beverages that can be bought in the general shop which, if a boy drinks enough of them, will make him drunk and probably give him a craving for stronger drink and in a few years time we will have chronic alcoholics on our hands.

The Minister said:

I should point out that the problem relates mainly to community consciousness.

I suppose most of our social ills relate to the same thing, but in today's society, which is such a violent one, even people with the best intentions cannot prevent the abuse of drink. They cannot stop people from getting drunk. It is a free society in that way. Nobody wants to be regarded as a kill-joy. The middle-aged alcoholic or even the alcoholic in his twenties is a tragedy certainly, but I feel strongly that we should not tolerate a situation in which children can obtain drink strong enough to make them drunk. It may be pointed out that this is not a matter for the Minister for Health, but he has done a good job as regards cigarette sales and he could, with the Minister for Justice, effect a system which would prevent youth being exploited. Perhaps the youngsters have some devious way of getting this drink but they get it and one does not have to travel very far to see evidence of this. The Minister said:

I am urgently concerned with the problem of reaching the heavy drinker before he becomes an alcoholic. In this field I feel there should be a real hope, through education, of arresting the progress towards alcoholism and I am confident that the recommendations of the Irish National Council will pay special attention to this aspect of the problem.

I hope they do indeed and that each one of us will pay great attention because if we do not we will reap a sad harvest in ten or 15 years time.

The Minister refers to the control of drugs. Drugs have been given a false glamour. We had films from the United States and other places which set out to show what a terrible thing it was to be a "junkie" but which overdramatised the situation and, indeed, introduced melodrama into it. Generally at the end of the film the drug addict was taken in hand by good people and saved from a horrible fate but these films gave a glamour to the drug scene. When youngsters hear about drugs they are naturally inclined to try them. Man is a very curious being. Our whole history shows us that man will eat the forbidden fruit. We should set out to show that there is nothing glamorous about the drug habit. It is a pernicious habit. The people who are making a profit from pushing drugs are the most depraved beings in any society. There is nothing heroic about them. We must despise them for the fact that they would wreck the lives of young people by selling drugs to make a profit. No normal person has any sympathy with the drug pusher but even as we condemn him we are inclined to glamourise him a little—the secret, furtive figure who moves around the city. One district justice said the other day that any young man in Dublin with long hair will be offered drugs for sale. We hear of places where drugs can be obtained. We note with satisfaction the work being done by the Garda drug squad but in a city of 800,000 people. while admittedly the number involved with drugs would be a very small fraction, the handful of gardaí, who are doing a great job, should be increased and given every possible help and facility to get after the people who import the drugs and the people who sell them. Let us show the youth that there is nothing heroic about these people, that they are merely out to exploit young people to make a profit and they do not care what is the eventual fate of the young drug addict. We must take away the glamour from the drug scene and show what a sordid depraved racket it is. The people engaged in it are no better than gangsters. The Chicago gangster who fought the gun battle at least took some chance that he might be shot himself but the people who import the drugs take good care that they will not use the drugs and they can seemingly reduce the possibility of their being arrested. There is no use saying they are mentally ill. If they were they would not be able to show the real cunning they have shown in avoiding the police and getting the young people of this city to take drugs.

We may say, if it is any comfort to us, that our problem here is very small compared with other countries. This is quite true but it will escalate unless we have the social conscience which the Minister speaks of and take really effective action by ensuring that the Garda drug squad is fitted with the most modern equipment and that expense is not spared on these men so that they can track down the criminals who are so horribly using young people today.

A number of drug treatment centres have been established. The problem is how to get addicts to attend for treatment. This applies in the case of any social disease. It is important that arrangements should be made for privacy so as to make attendance more attractive. It is difficult to provide a clinic that will be so private that the public do not know about it while persons needing treatment do know about it.

The Minister also referred to arrangements for the care of the aged. Today the society in which we live cares greatly for the aged but, to my shame, in many places in this city old persons are suffering at the hands of vandals. At night they have to endure breaking of windows and other forms of torture. We wonder why this happens when it did not happen when we were young. We were not saints but old persons were not subject to the sort of persecution experienced by old people in some parts of this city at the present time.

It was heartening to hear from the Minister what the Department are doing in the matter of care for the aged. It may be said that other Departments should be doing more. The Government of course provide the necessary finances for the building of homes for the aged. The Minister referred to the new style welfare homes to be provided by health boards which are nearly completed at Kilrush, County Clare. He said:

These homes will provide for frail old people who cannot continue to live in the community, even with the aid of supportive services, but who nevertheless do not need to be hospitalised on a long-stay basis.

We are getting to the kernel of the problem. Up to a few years ago, old people who could not be kept at home, who were not mobile and could not look after themselves, were put into hospital and left there until they became senile and eventually died. Society had felt it had done its part in at least taking them off the street. Therefore, we welcome the open outlook of the Minister and his Department in not shelving these people but providing special homes for them. They will not be there on a long-stay basis. This shows that we do care for the aged. The mark of any civilisation is how it deals with its elderly people. It was gratifying that the Minister devoted such a large part of his speech to what is being done in this respect.

The Minister also referred to the care of the mentally handicapped and said:

It may be of interest to the House to know that the facilities already available and in course of expansion in this country for providing residential care for the mentally handicapped are proportionately greater than in Great Britain. I am told that, in general, our service bears favourable comparison with that of most countries in the world.

I am sure it does. At the same time let us not be complacent. We can point very quickly to the many handicapped children who cannot be placed in residential accommodation. It is gratifying to know that we are increasing the accommodation, but in my view it is not being increased fast enough. There are ways and means open to us of providing this accommodation. Many years ago when we were considering building a memorial hall in memory of the late President Kennedy I suggested that we should provide a hospital for mentally handicapped children. It may be suggested that this is to make a virtue of necessity but I see nothing wrong in that. If that suggestion had been adopted the building could have been provided long ago as a great memorial. Young people could get the best possible training in such an institution.

If there is the least possible hope of a handicapped child benefiting from training, that training should be provided. This would give parents some peace of mind. They would realise that in the event of their death their children would not be left to the casual care of society. The Minister has done tremendously well in this field but I would urge him not to be complacent. I do not like the word "institution" but I do suggest that there should be a remedial home established for these children. The number of children involved is not very great and it can readily be estimated that £x million will be needed to provide places for all mentally handicapped children. The public will not complain about increased taxation if they know that the revenue will be spent on such a worthy undertaking.

The Minister also referred to child health services and said:

A new child health service, which aims at identifying physical and mental ailments of children at the earliest possible stage and at referring them for appropriate treatment was introduced in the larger cities in October, 1970.

This service has been in operation for two years. However, in some schools teachers have to take very mixed classes and in many cases the teacher has to discover the slow learners. I give every credit to those teachers from the primary school upwards who devote time and attention to this problem. However, is it fair to ask the teachers to do this work? There should be increased phychiatric screening services so that physical and mental ailments could be identified at the earliest possible stage and suitable training devised to help the child to overcome the disability.

There should be greater emphasis on school medical examinations. These examinations should continue throughout the child's school life. It is not possible at present to cover all the schools even in the city of Dublin. I do not know how often a school medical examination takes place but I would say that it is not too often. It may be a matter of years before a school, once visited by the school medical officers, is re-examined. In 1970 41 per cent of the national schools were visited. Many thousands of children were examined medically. What happened the other 59 per cent of the schools? Were the children examined the previous year? When will they be examined again? The frequency of the school medical examinations should be increased to find out what ailments the children have and to refer them to specialists for proper treatment.

The Minister spoke about health education. This is very important. Health education is preferable to compulsion. If we educate people in health matters we will not need compulsion afterwards to make them comply with the laws of health. The Minister spoke about educating the public. Great use has been made of television in this respect. The revenue of RTE has been affected by loss of income from cigarette advertising. We must face the possibility of having to cut back on programmes if RTE do not get enough money. We should note the action taken in refusing cigarette advertising and we should ensure the necessary revenue for the running of a good service. Well-known people such as a television announcer, a rugby international, a manager of a football team and an amateur boxer have appeared on television. I suppose they make some impact. If we are to encourage young people not to smoke a much more imaginative approach will be necessary. We must concentrate on the young. The Minister should encourage shopkeepers not to sell cigarettes to school-going youngsters. Other shopkeepers should be encouraged to refuse to sell cider, which is alcoholic. Steps like these should guide the youth to a proper way of life.

I want to compliment the Minister on his efforts over the years. He has brought the Department of Health to a high standard. I wish him well in the coming year and hope he will not only continue but double his efforts particularly with regard to the care of mentally handicapped children, the prevention of alcoholism, the care of the aged and the prevention of smoking. If the Minister reaches the targets he has set himself he will go down in history as one of our greatest Ministers.

No one can accuse the Minister for Health of not producing long and tabulated statements, possibly backed up by statistics. It is desirable that the Minister should give us the fullest information possible and let us know his own thinking. Even though we may not agree with him, it is nice to know the Minister's thinking. The Minister produced a concise statement a few weeks ago. I have not yet read the Minister's speech in full. The concise statement covers a wide variety of subjects. It deals with assistance for the middle-income group in regard to the cost of drugs. The number of medical cards issued is largely due to the extortionate price of drugs. Drug prices have risen by over 100 per cent in the last few years. I am often approached by people in my constituency who are seeking medical cards. A young man earning £20 a week with three or four children may look for a medical card because he finds that he has to pay £1.50 to the doctor while the chemist's bill costs him another £2. The Minister is on a winner when he introduces a scheme for providing free drugs in certain circumstances, or a subsidy towards the cost of medical prescriptions.

Many drugs are given to patients in clinics. The Department of Health have no hard and fast rules in relation to the supply of drugs through chemists. I am in favour of the chemists handling drugs so far as possible. The chemist shop is usually a private enterprise. I favour that. One of the discouraging things has been to see so many chemists being forced to close down over the last few years. Many drugs are supplied at the clinics and this does chemists out of business. Chemists have said that if they were handling all the business they would be able to produce drugs more cheaply. The Minister might look at this point. There could be a considerable saving in State expense here.

The Minister referred to section 61 of the Act under which people were given allowances with the object of keeping elderly people out of the county homes. I am not sure of the cost of keeping patients in county homes at the moment. I know they are not called county homes now. They are called St. So-and-So and the dispensaries are called clinics. It costs a minimum of £10.50 per week to keep an old person in such a home. In the future the cost is more likely to be £15.75 to £21 per week. There is no active scheme in operation at the moment. One has to make a representation to the health boards to get an allowance to keep a person at home to look after an invalid or an elderly person. The Minister says this is something which will be considered in the near future. It should be brought into operation immediately.

At the moment if an elderly person or an invalid is to be kept out of an institution an application must be made to the Department of Social Welfare for an allowance of £2.75 for somebody to look after that person. It is very hard in this modern age to get somebody to leave a good job and stay at home to look after an elderly person for an allowance of £2.75. The Minister should bring in a scheme immediately whereby people can get substantial allowances for looking after elderly people and invalids, such as people suffering from schlerosis, paraplegia and other paralysing diseases. The minimum allowance should be £5 a week. If a person is earning £15 or £20 a week £5 is the least which can be given to her to remain at home and look after a sick or elderly relative. This is money saved for the State because it would cost much more to keep any person like that in a State institution.

The Minister did not say whether his scheme is under immediate consideration or under active consideration. I hope it will be introduced as soon as possible. The Minister will save quite a sizeable sum by bringing this scheme into operation. The county institution in Wexford, which is now known as St. John's Home, is full and there is a long waiting list. In fact, the only time you can get somebody in there is when a person dies. The Minister is a very hard worker, but I hope he will find time to go around to some of those institutions and he will find that what I say is true. I know this is the position all over the country. I believe that 25 per cent of the people in institutions need not be there if the Minister operated his scheme as quickly as possible.

There is more muddled thinking over the cost of health services than anything else in the country. There are people who say that everybody should be entitled to free medical services. Perhaps the Minister saw the programme on the BBC a few nights ago when they dealt with the question of the hospital services in the United Kingdom. Everybody there is entitled to free medical services, but, of course, that is all right on paper, but on this programme we were told that there is a shortage of surgical and other consultants, a shortage of nursing staff and even a shortage of hospital registrars, although they can be replaced by putting coloured people in their places. There is a long waiting list for what are known as cold operations, that is operations like hernia and varicose veins which means that the operation has not to be done immediately. The waiting list for those cases is two years. The result of this is that they have had to introduce a private system alongside the State services. In a hospital in Birmingham there are six operating surgeons and of those two are part-time which means that they can opt to do private practice if they wish. The cold operative cases can be attended to by those people if they are paid.

I refer to this to show that if one relies entirely on the State for everything it ends in a backlog. That backlog has existed for years in the United Kingdom and is growing all the time The Right Honourable Enoch Powell was on that programme and he said that when he was Minister for Health his first aim was to try to get rid of that backlog. He even encouraged part-time surgeons and when he ceased to be Minister for Health, he said the backlog was bigger than it was before. The last Labour Minister for Health agreed with him and said that he did all he could to remove the backlog but failed.

I want to impress on the Minister and those who advise him that you cannot function properly on a State medical service solely. I agree that the State must assist and must play a vital part. Alongside that you must have private enterprise. You want both to work together.

I want to refer to a private enterprise with which I have had the honour to be associated and which has been entirely successful. I understand the Minister is coming to County Wexford on Monday to open an institution which has been brought about by private enterprise. The Department of Education as well as the Department of Health have to do with mentally retarded children. I took an interest in handicapped children with other people who act on a committee with me in County Wexford. We made a mistake in the beginning when we decided we should get the State to do everything. We had no money and we thought the State should help us. We attacked the Department of Health but we never got anywhere. We thought they were unreasonable and they thought we were unreasonable. I have since come to the conclusion that we were both unreasonable. We should have met each other half way. In the end we adopted the attitude that nobody would do anything for us, that we would have to do everything ourselves. We collected a certain sum of money and we started on this home, independent of the State. If you start something on your own bureaucracy disappears overnight. The State comes in and helps you. We have worked on this committee. We now have two schools functioning properly there. We have the full blessing of the Department of Education and, I believe, of the Department of Health. We have an institution which the Minister is coming to open on Monday. That institution was bought partly by the county council, as it then existed, and partly by the Department of Health. It is administered by the regional health board, but they have handed it over to us, the Committee for the Mentally Handicapped, to administer and run and to subvent by our own funds. I am sure the Minister will be pleased with what he sees. It is a well-run institution and run much cheaper than if it were run entirely by the State.

Coming back to costs again, I believe the Minister and probably those who advise him as well, have done a lot of renewed thinking. From these benches it has been long advocated that the individual person is responsible for contributing towards the maintenance of health services where he is able to do so. There are other people who hold the opposite point of view, that it is a matter for the State. I think I dealt with that problem, pointing out what we heard on the BBC the other night that Britain was not the be all and end all in the matter of health services.

I am glad to see the Minister has come a little way towards our line of thinking. He is instituting a levy of £7 a year on all land owners under a valuation of £60. That produces £5 million a year. It is really an infinitesimal sum compared to the very high charges for health, but at least it is a move in the right direction. I would suggest to the Minister to go further. There are three income groups. There is the lower income group, those who are unable to pay for anything themselves. In the past they were the dispensary patients and now I suppose they are the people who attend clinics with blue cards. Then there is the middle income group, which is perhaps the hardest hit group in the community today. They are the people who are living on fixed incomes and who have to pay for all the domiciliary treatment.

This is where the health services are deficient. There is nothing to meet a domiciliary service at all. The £7 levy, which I think is paid by people in the lower income group as well—I am not sure—does not go anyway towards meeting domiciliary treatment. The problem all down the years is that our hospitals have been filling up, that there are people in hospital who should never be in hospital. Whether they are in geriatric hospitals, acute surgical hospitals or medical clinics, they are there because there is no free domiciliary treatment. There are many people in the middle income group who are pouring into hospitals because they get free medical treatment. If they could get free domiciliary treatment they would not go into hospital.

If the Minister does not agree with the contributory system suggested by the Fine Gael Party, I would ask him to look at the way other countries run their services. They have three distinct groups. There is the lower group who cannot pay anything. We are satisfied with that. Then there is a phased contribution over the middle income group. May I take the middle income group as being a group of fairly high artisan workers who earn a pretty useful wage, those earning salaries right up to the middle classes, the professional people. There should be a graded contribution for them. Then let the higher income group pay a higher contribution. I think you, a Leas-Cheann Comhairle, would possibly come into the higher income group in view of the generous salary paid to you by the State. If so, I am sure you would join with me in being satisfied to pay a sum of money like that.

By a domiciliary treatment I mean a general practitioner treatment for people at home. People in the middle income group are struggling to make ends meet, to pay their rent, rates, insurance premiums and so on, and unfortunately the rates are going up every day under Fianna Fáil. Every year the Minister comes back here looking for more and more money. Consultations are held between the local authorities concerned and the Department of Health in order to try and stop the escalation of the rates. I am told now that a public ward in a hospital costs, on average, £24 a week. When I was practising as a doctor 25 years ago I can remember ringing up the voluntary hospitals in Dublin, before we had all this voluntary health service, and asking them to take a patient at two guineas a week. Now there is no use in my ringing up because they cannot take anybody at a cheaper rate. The rate is fixed. There are definite fees and definite sums available.

As I say, I am glad to see that the Minister is gradually moving towards the contributory service, but I say without fear of contradiction, that the £7 he is charging is absolutely valueless without a domiciliary service.

Progress reported; Committee to sit again.
The Dáil adjourned at 5 p.m. until 3 p.m. on Tuesday, 14th March, 1972.
Barr
Roinn