I will not delay the House any longer than is necessary but there are a few points in the Minister's brief I want to refer to. I read recently in one of the newspapers that the Minister, speaking at the Coombe Hospital, stated that the figure for the coming year would be £84.3 million for health expenditure. This is a fantastic increase and it indicates the phenomenon which has occurred in the provision of medical services for the community. One cannot help however but compare this increase with what the general public spend on alcohol. It is estimated that last year something in the region of £110 million was spent on drink. I believe that, from the grassroots to the top, we have our priorities wrong.
Many steps have been taken by the Department of Health and we have heard some Deputies here praise the Minister for the work he has done. I do not come here to praise the Estimate but to criticise it in the most constructive way I can. There are aspects of the Minister's brief which I feel are possibly misleading. In the third paragraph of page 1 the Minister states:
These increases are attributable largely to improved pay and improved conditions of service for staff and the rising costs of drugs, medicines, foodstuffs and so forth.
The rising cost of medicines has not been helped by successive Ministers or by successive Budgets. Turnover tax on two separate occasions has been levied on medicines. This is possibly a budgetary matter, but I feel, since the Minister mentioned this in his brief, I am at liberty to comment on one of the reasons for the rise in the cost of drugs in this country. This is not totally outside the control of the Government. The turnover tax on medicines, as originally imposed and as later increased, is one of the contributory factors for the increase in the cost. It is impossible for the Minister to estimate the amount of money spent by private patients on medicines at local level.
There is great discontent among patients who are not covered for free drugs and they represent 90 per cent of the population. These people have to pay rates but they have little or no provision made for them at general medical services level. Deputy O'Donovan mentioned the increase in postal charges. When a patient is sent into hospital by a general practitioner the consultant sends a report to him and this postage has increased very much over the last few years. This has not helped the situation. I would like to see all forms of health accessories, all medicines and medical instruments exempted from the excessive taxation which the Government impose at least annually, if not bi-annually.
When the Government imposed turnover tax on drugs they exempted medicines for cats, canaries and household pets. It might not mean more than an extra few shillings in the £ every year if it only occurs once or twice in a family but in a chronic illness, which is not covered under the regulations which the Minister made effective from 1st October last, it means a big increase. These regulations give power to health boards to provide free of charge drugs and medicines to people under 16 years of age who are suffering from mental handicap, cystic fibrosis, epilepsy, diabetes, haemophilia, spina bifida, and cerebral palsy. There is no harm in pointing out that when we were asking the Minister to state his bona fides in regard to making medicines available for these categories of people there were many other classifications of patients we wanted included in this.
We appreciate the Minister's response to the numerous representations made by different voluntary boards who have got together to present their case to the Department of Health to provide some form of relief for these illnesses but there are other illnesses which could be included in this. Asthma is one of those. I know there are different types of asthma but certainly bronchogenic asthma should be included in this category. It is a very difficult illness to treat unless one has a free hand as regards the types of medicines used. Medicines which have come out during the past decade for the treatment of asthma are very expensive.
Asthma can be treated very successfully with modern drugs but where a private patient is on the borderline and does not qualify with a health board for the supply of free medicines in a case of bronchogenic asthma, which a patient suffers from for many years, it can impose a heavy cost on the patient. This should certainly be included in the category of diseases for free medicines. The quality of treatment and the quality of therapy that a general practitioner can give to a person suffering from the specific type of asthma I mentioned would greatly improve the patient's health and could restore him as close to normal as possible with the present compounds that are available, but they are so expensive that they are outside most people's pocket at the moment.
There is another disease which should be included here—I know it is a wide type of definition as regards disease—and that is arthritis. I do not mean lumbago or other such aches or pains, but osteo-arthritis or rheumatoid-arthritis where there is a specific disease diagnosed and where the general practitioner has to certify that the patient is suffering from this. If osteo-arthritis and rheumatoid-arthritis were included it could cover the vast number of those who do need the most expensive medicines, particular gold injections, cortisone treatments and so on which are given for these diseases.
There is another disease which one comes across every day, that is blood pressure or hypertension. This is a disease which can require very prolonged treatment. We have seen some excellent programmes on television which have come into the country from abroad indicating how chronic this disease can be, the effect it can have upon the patient, upon his family life, upon his performance at work and on everything he does. Yet this is a disease 70 per cent of the cause of which is never found, but one of the remarkable things about that disease is that the treatment, which is long-term treatment, can produce all the symptoms which result from the disease hypertension. Here again at general practitioner level we are not going to disguise the fact that people are not wealthy. They are not well off and you cannot prescribe the up-to-date medicines for a hypertensive person when you know that the very cost of the medicine will result in his getting upset and raising his blood pressure. Even though there is some provision whereby he can bring his prescription to the health board and get a month's supply until his case is investigated, there is far too much inquiry into cases like this. Due to the way in which the cost of living has increased nearly every second patient goes to James's Street to try to get his medicines free.
The fourth type of disease which I think should be included is chronic bronchitis and emphysema. In the city of Dublin there is smoke pollution which is twice that of London city. This is one of the factors in chronic bronchitis. Due to our failures as administrators and legislators we have allowed that to happen. A person might have a job in a mine or in industry which is not helping the respiratory system. Our damp climate, particularly for six months of the year, is also a factor. The first thing one is taught in medical school is to tell anyone who has chronic bronchitis to go to the Meditteranean. People cannot afford that, but there are many medicines which can give relief to a chronic bronchitic for the winter months. While once again there may be provision whereby a chronic bronchitic can get a week-to-week or month-to-month supply of drugs, I think that should be dispensed with and that such a person should be included among those entitled to free medicine.
Another disease which should be included is angina. Any person who has a coronary attack as a result of which he requires treatment for the rest of his life should get the benefit of this provision. In fact, any disease which lasts or is likely to last longer than three to five years should be automatically included. One thing I am pleased to see in this connection is that there is no means test in connection with these diseases, but the application form which a person has to fill in when he is applying for free drugs or a medical card contains many questions of a personal nature: his weekly wage or other income, overtime, bonus or other allowances; what the rent is, what the mortgage payments are, ground rent, rates, rateable valuation and special circumstances, if any. Then after that his house is inspected and possibly, if his furniture is good and shiny, if there is a television set, a telephone and so on, his application may be refused.
I have replies back from the Eastern Health Board indicating the number of people being refused or possibly having difficulty in obtaining the evidence necessary to give to the Eastern Health Board. There is a great deal of bureaucracy involved. The applicant has to go to his employer or to the secretary of the company for which he is working, get an income tax certificate, details of what he has earned for the year and so on. This can be embarrassing for certain people and they may not like to do it. It is time we got away from counting the chickens in the farmyard and having a look at the furniture in the house and made a reasonable provision in respect of those suffering from chronic illnesses.
May I point out, without being too severely critical of the Minister, that under his Ministry, for the first time as far as I can remember in any country in the world there has been a strike of junior hospital doctors here. Nurses have paraded in their uniforms and carried banners outside Dáil Éireann, certainly not what their parents intended them to do when they started them off in nursing, or when they entered that great vocation. There was a threatened strike of dispensary doctors about two years ago so that they could have a day-and-a-half off a week. We have had the tragic strike of the psychiatric nurses, something everybody was bewildered about. Nobody could understand how it could have been allowed to go to such an extent. I was not surprised that it was allowed to boil over, that once again the Minister was trying to capitalise on the nature, the vocation, of the psychiatric nurses. It had happened before in regard to the junior hospital doctors who found they could not live on the salaries they were getting for the hours they worked. The psychiatric nurses found themselves in difficulties with the cost of uniforms and the cost of meals going up. Earlier the dispensary doctors had the same experience. All of these strikes came right up to the full bluff point but the psychiatric nurses' strike was the one that exploded. Many of us know of the tragedies that resulted from that strike in certain parts of the country. We have had the dentists' dispute.
That is not a great record. I am not criticising the Minister as a person, though I shall have plenty of criticisms to offer later. I am criticising his general administration. No other country in the world has had that record in the two and a half years the Minister has been in that office.
The dentists, from a poll of 64 per cent, have voted 84 per cent in favour of the new proposals. I am glad to hear it and I hope they abide by that decision. It is good to think that the dental services will be back in action. However, a point that is often made, and there is great validity in it, is that once you cross the Border you can notice the difference in dental hygiene as between residents in the North and the South. The services here are very poor. Only the mother who has a medical card and who is pregnant is entitled to dental treatment in the local dispensary area. Only the man who pays his insurance stamps is entitled to dental treatment with a private practitioner. Where does the mother go in regard to her children? Where does the man go who has not got a medical card? For the adults, they can go to the Dental Hospital which has, as we know, quite a large number of people on its waiting list which closed in June 1970. The Minister told us that the reason for this was that the number of persons awaiting this service was beyond the ability of the hospital to deal with. He said the matter was plainly one for the Eastern Health Board. That may be so, but if the Minister is subsidising the Eastern Health Board to the extent he says he is, it is also a matter for the Minister. If our party were in office I would not expect Deputy R. Barry to make such an observation or to try to pass the buck in that way. I am surprised at the Minister in this respect.
For instance, I asked a question about somebody who could not get treatment for a particular illness. I was told to go to the Eastern Health Board. Practically every question asked of the Minister is referred to that board. One of the few democratic rights we have in the House is the Parliamentary question.
Three of the previous five speakers dealt with particular matters about which I have a certain amount of knowledge. I do not say I have the same knowledge as the Minister has. Let us consider what Deputy Mrs. Burke said regarding the hospital in her constituency. It is a short distance from where I was reared in north Longford. I very often travel there and I know the difficulties and the feelings of apprehension at the down-grading of that hospital. It ill becomes any Minister to say it will not be down-graded in the way Deputy Mrs. Burke stated. In this respect I would urge the Minister to reconsider parts of the FitzGerald Report, written by a committee chaired by Professor Paddy FitzGerald. It is a good document but since its issue we have had the results of a census. The report was based on the old census but left a certain amount of leeway for changes in the population. I do not think it covered fully the changes revealed in the new census. Deputy O'Sullivan mentioned a hospital in Kerry.
