Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Wednesday, 15 Mar 1972

Vol. 259 No. 11

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

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

I want to thank the Deputies on both sides who contributed most constructively to the debate. First of all, I had better deal with the questions that were raised in relation to the cost of health services. Deputy Barry and some other Deputies suggested that the Exchequer should assume full liability. To do what has been suggested would in the coming financial year involve the transfer of about £25 million from local to central taxation. This would have to be considered by the Government as a matter of major financial policy. I myself believe that whatever the arguments may be for the division of health expenditure as between the rating authorities and the Central Government, the rating authorities should always have some responsibility for raising money because, if the whole of the amount were subscribed by the State, they would lose all the independence they have in establishing health policy and establishing priorities in health policy.

To raise this additional amount from taxation would require an extra 2½ per cent on turnover tax or an extra 6p in the £ in income tax or crippling increases in the duties on such items as drink and petrol. The whole of this matter is coming up for consideration by the Minister for Local Government. There have been many reports on ways and means of changing the rating structure. The Minister for Local Government can speak far more ably on this subject than I can. There is the question of the possible need for a re-valuation.

I want now to repeat what I said in the course of my speech on the Estimate that about 75 per cent of the total health services are paid for from central taxation. The £9 million a year coming from agricultural rating relief is quite rightly included because the agricultural rate relief, which is a subvention from the State to relieve rates on agricultural land, is applied in proportion to the total expenditure of local authorities. It is applied in proportion to the health expenditure in each county area and it is, therefore, perfectly fair to include the agricultural rate relief. That being the case, the State is paying for 75 per cent of the health services.

I admit that in the urban areas that rate relief does not apply and health rates bear very heavily on ratepayers. Although the paper I issued to Deputies and to health board members, analysing the breakdown of the increased expenditure by health authorities this year, does not apply to the 1971-72 accounts, as Deputies freely went beyond the 1971-72 period in their speeches and referred to current health policy and even to such items as choice of doctor, which only begins on April 1st, no one will, I think, object if I repeat what I wrote to Deputies: of the increased expenditure for health in the coming year £9.55 million represents increases entirely related to remuneration, the increased cost of commodities, the increased cost of drugs, food and maintenance, the effect of reducing the hours of working to 40 with a consequent introduction of new staff, and a very tiny element, which it was impossible to separate from the accounts, for increased numbers of patients. For new services and for extensions to and improvements in existing services the total increase this year is £3 million. That means that there will be in the coming year a volume increase of 4 per cent on the cost of the health services as compared with last year.

I understand that in even wealthier countries than ours a volume increase of anything between 3 and 5 per cent is considered acceptable. On the basis of compound interest this means, of course, that the volume of health services in constant money terms doubles in 15 years. In fact, vis-à-vis the volume of health services at constant money terms, disregarding increases in remuneration, not only in the last decade but for a longer period, the total value of production went up by about 50 to 60 per cent which means that, in order to improve the health services, after disallowing the heavy costs of remuneration increases, the people have willed a very great increase in expenditure. Now this is absolutely essential if the services provided are to keep us in the group with the ten top countries in the world in which, according to the WHO statistics, we belong at this moment; the statistical tables provided by that organisation indicate in general the state of the health services and the state of the health of the nation. I do not think I need say any more on that subject.

I was very glad to be able to keep the increase in the rates at an average of 30p for this year. We are constantly examining this question of the rating structure. There are many problems in connection with it. We have passed a law which enables an additional rate to be levied to relieve rates on necessitous persons. That law has been applied in different measure in different counties by the different rating authorities. It serves a very useful purpose. Again, people can now pay rates by instalments if the respective authorities provide the necessary machinery. I agree that rates bear very heavily on the community but I notice that the increase in rates in relation to the growth in production shows that production has grown to the extent where it measures up against the growth in rates.

We are, admittedly, a fairly heavily taxed country; 30 per cent of the total value of production and of all services is taken in taxes and rates. Again, that places us amongst the respectable top ten countries in all of which there is a common feature of high taxation. While rates may bear very heavily on people with fixed incomes, part of the unpopularity of rates lies in the payment of two moieties. Now, if a person has to pay £60 in rates in two moieties over 12 months, that is about the same as he would pay by way of tax on petrol for a car of medium size over a distance of 10,000 miles or about the same as smoking 20 cigarettes every day. I am not now trying to excuse the heavy impact of the rates. I am merely indicating that the unpopularity lies in the money payment as distinct from the subtraction of tax by PAYE or as distinct from the excise tax automatically paid when one purchases a pint of stout, a packet of cigarettes or a gallon of petrol. I merely mention that in passing. That is all I can say on the subject of the difficulty of transferring the whole burden of rates to central taxation. I believe an additional 2½ per cent on turnover tax would not be very popular.

Deputy Tully raised the question of supplementary grants to limit rate increases. He said there was an apparent inequality of treatment in their application to different areas. Some areas get more supplementary grants than others in order to confine the health rate increase within the specified limits. I could not explain this without going into very great detail, but I can assure the Deputy and those others who raised the point that the differences which exist are not caused by either extravagant spending or bad estimation.

An example may illustrate the point. For instance, because of the big difference in valuation it would take almost as much special grant to give County Meath the equivalent of 14 pence in the £ relief as it would to give County Monaghan the equivalent of nearly 30 pence in the £ relief. Furthermore, it should be borne in mind that areas which utilise the services of the voluntary hospitals to any appreciable extent are already getting considerable relief through the medium of the grant-in-aid of the Hospitals Trust Fund as compared with those areas which provide the necessary services in their own hospitals. Therefore, there is nothing we can do about the matter which he raised.

A number of Deputies raised the question of the health contributions under the Health Contributions Act. I have given a very clear description to Deputies of the circumstances in which the Health Contributions Act was started. Some Deputies suggested that we could extend the family doctor service to persons in the limited eligibility class and finance it by an increase in the health contributions. The health contribution brings us in £5 million gross, £4.3 million net. The cost of extending the family doctor service to the limited eligibility class cannot be easily calculated accurately, but I would say it would be between £20 million and £25 million. It will immediately be seen that a very heavy contribution would have to be levied for this purpose. The question of what the level of the health contribution in future would be depends on the total Exchequer position in relation to health policy, but the Government have decided that if one was to levy more than £7 a year and to do it because people are demanding better and better health services and they are going to become more expensive as the years go by it would only be fair to do it if you could have a payrelated form of contribution. I understand that the Minister for Finance is preparing a computerised system enabling pay related social welfare benefits to be introduced as indicated as a long-term promise by the Minister for Social Welfare. When we can have pay related social welfare benefits we will also be able to have pay related health contributions.

You will then have Fine Gael policy implemented.

The Deputy may say that but the fact is that the Deputy is way out on this subject of being able to provide a full insured policy for health. I am sorry to tell the Deputy that if you take countries like Denmark and the Netherlands, where because of their history as free nations and their belief in the co-operative system, they started very early to establish co-operative insurance and where they were accustomed to the co-operative principle, accustomed to sharing the benefits and costs of co-operative enterprise, in every single one of those States the insurance principle has completely broken down because of the high cost of hospitalisation. In every single one of them either the municipalities or the State Government largely subsidise the hospital service for the insured groups and this for reasons that relate to the psychology of taxation. We cannot discuss that this evening but apparently every Government in the world has a hunch that you cannot increase an insurance contribution by more than X per cent per year and if you do it you either lose your seats in Parliament or there is a protest and, therefore, you substitute for that general taxation or, alternatively, you try to have as a substitute for general taxation an insurance amount and then, again, the amount you can have for insurance is limited. Deputy Barry will find, if he studies the health services of Europe, that in every case this element of subsidisation is compulsorily enforced because of the psychological impact effect of a total insurance contribution on the people who have to pay. If he studies it he will find that I am right in saying this.

The British are the best example. They began with a total service from the cradle to the grave under the wonderful Sir William Beveridge. He will always be revered for what he did in 1944. He could never predict what the costs of health or social welfare would be. He thought it was going to be a total insurance operation and now, as Deputy Hogan will know from my answer to his question, the total proportion of health expenditure met in Great Britain from social insurance was something between 2½ and 4 per cent of the total cost. There is an example where the insurance principle completely collapsed and you now have in England a huge sum levied on the ordinary taxpayer for the health services. This is a very difficult question.

Next is the question of standards of eligibility for medical cards. As indicated by some Deputies, there were about 20 different standards being used for medical cards——


——and in some counties there was not even a written standard. A written standard was kept in a drawer, not in any deceiving way, but it was never openly applied. It was simply used as a private guideline by the county manager and by the superintendent assistance officer. I want to make it quite clear also that there were some counties where the Health Act, 1953 provision that every medical card must be constantly revised was not being obeyed or followed. When the new chief executive officers came into office before they decided to examine medical card standards they did at least begin to revise medical cards where the incomes of the people had clearly surpassed the medical card upper limit. What we have asked the CEOs to do is to try to get uniformity for medical cards within their health boards areas. Then we are going to see whether through their own collaboration on an informal basis they have managed to establish a medical card standard that is fairly uniform over the whole country. That is what is being done. The only direction I gave was that I did not see that it was necessary to increase the number of medical card holders all over the country. I was aware of the fact that there were going to be minuses and pluses. There were going to be people who went to a private doctor and who did not have much hospital experience or need to go to hospital and who consequently did not take out a medical card because they wanted to go to a private doctor whom they had to pay. Those people, now that there is the choice of doctor system, are liable to take medical cards if they are within the statutory limits. That would be a plus.

There would be minuses in the case of people who never should have had medical cards. I just gave a general instruction to try to keep the number at 30 per cent of the total which I think is reasonable and I have not had many complaints in this House that the medical card standard based on 30 per cent of the population is unreasonable. I have asked the CEOs to complete this task so that at most we will have eight standards in operation and that there will be a very considerable degree of similarity between the standards. This time the standards will be published so that everybody will know that the hardship rule at the upper end of the medical card limit of income will still operate and the person who normally would not get a medical card because his income came just above the top limit, if he has the continuing and very often harrowing experience of the need for general practitioner service and the need for drug service, will continue to get the medical card either temporarily over an emergency period in the life of his family and himself or permanently if he has to go constantly to a doctor. The hardship clause will remain.

I was asked about the comparison with Northern Ireland health services. I want to be followed very carefully and accurately by our good friends in the Press when I speak of this because I do not want to have my words misapplied.

It is not usual for the Press to do that.

I know. I am not suggesting that they do. But I do not want them to leave out a sentence because it could place me in a very difficult position. I have plenty of evidence from Irish doctors who have been in Great Britain that our health service is generally comparable in quality with that in Great Britain and I have not been contradicted when I have made that statement.

I will contradict you now and say, ask the patients.

Well, the Deputy can.

Ask the patients. I am speaking as a doctor. Ask the patients.

I disagree with Deputy O'Connell. The World Health Organisation figures and the figures in Great Britain and Northern Ireland for infantile mortality, perinatal mortality and, above all, the cold-blooded figures of insurance companies for expectancy of life in this country, whether at the age of 50 or at the age of birth or the age of 35, place us level with Great Britain and Northern Ireland.

I am talking about the cost.

Having said that, if the day of reunification should come, we would obviously have to harmonise our health services with those of Northern Ireland. I do not think there would be any harm if we negotiated this. If the system we adopt here proved acceptable to the people in Northern Ireland, with a very much lower rate of taxation, then we could agree on our system or a compromise system. I recognise that in our position we would have to do everything to secure the consent of the people of Northern Ireland to reunification and we could not stand back on the proposition of whether there should be our triple system of the upper income group, the limited eligibility group and the medical card group. We could not stand back on it. I am only saying that it would cost an extra £30 million, as I have already indicated in reply to a question that was asked of me some months ago. We would have to find the money and we would do it but I want to say that I am not in the least ashamed of the services performed in our hospitals by our consultants in this country as compared with those in Great Britain.

Except that they cost more.

I am not in the least ashamed of the waiting lists for treatment of many kinds of illness as they exist in this country and compared with the waiting lists in England. I speak with knowledge on this subject and I hope everybody understands what I say. I agree that harmonisation is essential. I am merely pointing out that I am not in the least ashamed of the present triple system of aid that we have in this country.

Obviously, the people in the North do not think they want the system here. That is one of the obstacles to reunification. The Minister knows this.

In actual fact they have never had anything since 1944 but their system. They have no means of comparison.

They have relatives and friends here.

There has been much criticism, irresponsible criticism, by Deputy Coughlan, but not by many Deputies, of the operations of the health boards. I do not think I need repeat that the extra cost of headquarters staff amounts to one new halfpenny in the £. That is the total cost of the headquarters staff. I am not in the least ashamed of this amount. That amount of money can be very well spent in the organisation of the health services. Do I need to repeat to the House the main reasons for establishing the health boards? Quite simply, they are, the growing specialisation in hospitals and the fact that there is hardly a single county where all the patients go to the hospitals within that county and none of them go to the hospitals in an adjacent county and none of them go to Dublin for special treatment. Therefore, there was already a regionalisation of health board hospital services and in view of the growing specialisation it was at least essential to combine a number of counties, as was already the case in connection with the Dublin, Limerick and Waterford Health Authorities, before the Health Board Act was passed. It is essential to combine these counties in order to make the best use of bed accommodation, the best use of specialists and outpatient clinics. There is not a modern consultant in this country who would dispute that statement and, indeed, it is fully accepted by the vast majority of the elected members to the health boards that such an overall administration covering a number of counties is absolutely essential.

The second reason was the very great need for establishing far more community services, for establishing a wide range of social service councils. For this it is absolutely essential to offer a headquarters staff to the social workers, to the public health nurses, to everyone concerned in community health, a headquarters staff which would produce people with real expertise and ambition and, secondly, would offer promotion to those who join the service and in order to have better decentralised services it was absolutely essential to organise from larger areas.

The whole basis of the McKinsey Report was that the structure of the health board administration must be fully decentralised wherever this is required, that there must be local offices, there must be assistance officers to whom people can appeal over the question of medical cards and everything else. That kind of organisation is being established and making progress.

The last thing I wanted to say about the health boards is that they have been in operation only for less than a year in the full sense and in the case of some of them because of the rules we have for the appointment of staff, programme managers are not yet appointed and there have been a second group of advertisements and calls for examinations by the Local Appointments Commission. We have had difficulty in getting Volume 4 of the McKinsey Report, providing for the support staff of the health boards, accepted by some health boards. Others accepted it with alacrity or in a modified form. When we have the health boards operating properly they will be able to do something that was never done by the old county health authorities. First of all, they will be able to do multi-annual budgeting. They will have the national general health policy as declared by myself and supported by this House if it chooses to pass the Estimate for Health each year and chooses to keep my Government in office. They will have some concept of the volume of increase of money they can spend on matters other than increased remuneration and costs for existing services. They will have a report of the past performance of the health board services, on the efficiency of the services. They will have a proper management system for the health board hospitals, either a single administrator or a joint administrator, and they will have hospital committees.

Having these reports, they will be able to ensure efficiency. Then they will have a list of all the hospital projects, geriatric projects and other projects, that are required in the area, prepared for them partly through the advice of the country advisory health committees who maintain communication from individual counties with the health boards, partly through the submissions of the health board members themselves and partly through the officers. They will have a list of proposals for future expansion, for future capital expenditure and, based on the general national policy, they will then be able to make a meaningful choice of which of the items should be in priority. This will be a decision taken by the health board every year. This arrangement can only be completed when the whole of the health board structure is in operation and when the inevitable paper work and inevitable administrative arrangements are completed, so that the information can be provided in this kind of way.

May I ask the Minister if these will be autonomous bodies?

The health boards operate under the Health Act, 1970.

As autonomous bodies?

The Deputy should know the powers.

As autonomous bodies?

They are not autonomous bodies, no.

The Minister has the right to over-rule?

The Minister has the right of sanction of a great deal of expenditure and he has the right of providing the total amount of money required for the health services and he has the right to determine what should be the volume of increase available, that is to say, increases in the costs and the development of services that do not relate only to remuneration but also to expansion, to providing more beds and more out-patient clinics, more doctors.

And he has the right to over-rule any resolution passed by health boards?

To the extent that they conflict with general policy, yes, certainly.

Would you think that the Minister should have the right to over-rule——

The Deputy spoke for two and a half hours and he should allow the Minister to conclude.

I permitted the Minister to ask me questions.

That was very nice of the Deputy.

Would the Minister say if he would have the right to over-rule a resolution of the health board about old age pensioners who are holders of medical cards?

I would have to look into that. There is a volume of law about health and I am not prepared to answer spot questions like that.

Will the Minister look into the matter?

I might look into it. I do not think I need go into the question of the regional hospital boards and Comhairle na nOspidéal. The House will have ample time to examine these matters when they come before the House in July. They are part of the recommendations made in the White Paper and they will be brought in the form of a single resolution before the Dáil and the Seanad when they can be discussed. I gave a great deal of information in this House at the time of the Health Bill and in relation to the White Paper on the general character of these bodies and there is no need to discuss the matter now.

A number of Deputies raised the question of domiciliary care of the aged. It is the duty of the programme community manager to develop domiciliary care for the aged as much as possible. As those people who follow the health services in detail know, the care of the aged involves the establishment of rehabilitation and assessment services; it involves providing the right kind of accommodation for the chronic sick; and it involves providing the right kind of accommodation in pleasant surroundings for ambulant old people who are homeless. I am glad to say there are propositions for at least 20 hostels, each of 40 rooms, for the aged. Some of these hostels are in the course of construction, five or seven more will be built this year out of about 25 that are proposed for various parts of the country.

These hostels for the aged will be a great improvement on the county homes, even the improved county homes. However, if they are to succeed there will have to be voluntary services in the area, people who will visit the aged, who will talk with them and be of assistance to them, to support the small staff that will be appointed to each hostel. This year we had a small estimate for £150,000 for home help —one of the provisions of the Health Act, 1970. I hope this money will largely go to voluntary organisations with the consent of the local health boards.

In addition there will be an increase of £100,000, making £300,000 in all, as grants from my Department to health boards to help the voluntary organisations concerned with the care of the aged. We have increased the grant by £100,000. We did not spend much more than £250,000 last year, largely because although there has been a massive and welcome development of voluntary services for care of the aged we must go a great deal further.

Some Deputies referred to my observations on the psychiatric nurses strike. I wish to repeat that no one can tell me I have not intervened when I regarded it as right to do so in aid of those in the health services where there should be an improvement in their conditions, in the case of junior doctors and nurses in particular. Everyone knows I am not against fair conditions and wages but, bearing in mind the fact that an open hearing of the Labour Court was definitely arranged ten days before the strike took place, I regarded the strike as absolutely indefensible.

I am not going to read the House the list of complaints I received on what happened during the strike in many of the hospitals where the actions taken were far from desirable. I am not going to say any more about it, but I still say we do not need to be absolutely rigid in this country, that there can be no industry or services where arbitration is not accepted simply because it is the habit of the country to think in this protesting way. Why should we not go a little in the Swedish, the Danish and the Norwegian direction in regard to the acceptance of agreed arbitration for certain essential industries? If we are going to start with essential industries one might think of electricity but even more important than that is the care of the sick. We might all agree that never again will there be a strike where sick people are concerned. Now that we have the new conciliation system in the Department of Local Government for processing claims made by local authority staffs and health staffs, there should be even less occasion for the strike weapon in this connection.

Would the Minister not agree that on this important point it does not help to be too dictatorial?

I am not being dictatorial.

I am afraid it sounds very much like that.

I said why should we not be a little like the Swedes and other nations regarding acceptance of agreed arbitration. Some observations were made with regard to the mentally handicapped. I should like to repeat again that there are 1,400 places, the number required to complete the programme in hands at the moment. I have obtained the agreement of the Minister for Finance that lack of finance is not a bar to completing this programme. There will be between 350 and 400 places provided in each of the next three years. The religious organisations are moving as quickly as they can in the provision of these residential places but it takes time. It requires architectural plans, it requires due consideration, and staffs must be trained. I can tell the House that there is no financial hold-up for the completion of the 5,600 places suggested in the Report of the Commission on Mental Handicap; we have already provided some 4,250 places.

Deputy Barry inquired about the 13th round of remuneration for ambulance drivers. I understand that two of the unions agreed to proposals made by the Southern Health Board; the remaining union have objected and discussions are taking place with the local government staff negotiations board.

Deputy Tully raised the matter of Lourdes marriages. I am doing my best to get agreement about revisions in the Bill. I have not yet succeeded but I think I am nearing some agreement. A number of Deputies raised questions about when certain improvements were to be made in various hospitals. If the Deputies inquire from me I will be able to tell them what is happening with regard to each hospital project. I will not give to the House the list of Mid-Western Health Board projects that are in various stages of development. In reply to Deputy Coughlan, who seemed to suggest that nothing was being done in Limerick, I would point out that there are a great number of projects at various stages of development.

Observations were made with regard to short-stay treatment units. We are developing short-stay psychiatric units and there are about five projects in course of development. I intend to have as many such units as are required for the whole country. I regard as a matter of priority for the mental illness service the decentralisation of the present services. This has taken place steadily in Dublin and I hope it will also take place in other areas. Another priority is the expansion of out-patient clinics and the development of a psychiatric social workers service. Psychiatric social workers are rather scarce on the ground and we must try to recruit them. Another essential is the establishment of industrial therapy in all the mental hospitals. If Deputies read the projects for this year they will see that there is provision for the establishment of industrial and occupational therapy units in mental hospitals.

The reason these are regarded as priority measures is that a large number of young people are entering mental hospitals. We have four to six times the numbers entering mental hospitals in Scotland, Wales and England. We want to reduce the impact of schizophrenia among young people between the ages of 25 and 34 and so we regard industrial therapy, better out-patient clinics and short-stay clinics as the way to deal most effectively with the one group in the community that we want to cure of mental illness and that we want to avoid mental illness, if possible. We have approved a short-stay psychiatric unit at the James Connolly Memorial Hospital. I mentioned that in reply to a question by Deputy Clinton.

Some Deputies asked whether mass X-ray is any longer justified. We are examining this matter and I am inclined to agree that, perhaps, we should have greater selectivity in the cases that are X-rayed, having regard to the present position of TB in the country. This is under examination but we believe in maintaining the BCG vaccination which we think has had a very great effect in eliminating tuberculosis and preventing its onset.

A number of Deputies referred to the dental service. I have been quite frank with the House and I have said that the dental services, bearing in mind the enormous cost of the health services, are a low priority on my list. We have very greatly increased the number of permanent dental officers and sessions for dentists in the last four years and we have allowed for this year quite a considerable sum, £250,000 for improvements in this service. I hope it can be improved as rapidly as possible but, compared with such matters as the choice of doctor service and the drug assistance plan, I do not regard it as a high priority although I am aware of the problem.

Questions were raised about the treatment of drug abuse. We are going ahead with this as fast as we can. We have carried out the greater part of the recommendations of the Drug Abuse Committee and as the last one we have decided to inaugurate seminars for teachers, parents' associations and youth leaders. One of these seminars has already taken place and two more have been organised. We are including alcoholism in this project. In regard to alcoholism I have taken note of what Deputies have said.

Does the Minister intend to introduce the proposed new legislation in regard to drug abuse in this session?

No, not in this session. The Bill will be introduced as soon as possible.

Does the Minister not agree that it should be introduced in this session?

I agree that it should be introduced as soon as possible. In regard to alcoholism I have already asked the health boards to appoint a social worker with a great vocational gift for speaking and talking and understanding the problem of alcoholism so that all the associations and bodies interested in trying to prevent this fearful scourge can be alerted and can work together. I intend to take this problem from under the carpet by asking the National Council for Alcoholism to make the kind of inquiry into the incidence of excessive drinking which when the report is published will have the same shock effect, I hope, as the report of the working party on drug abuse had in relation to a relatively far less serious problem. Combating alcoholism is not only a question of dealing with the alcoholic when that alcoholic loses all personal control and willpower. That is an essential part of the programme but it is even more essential to try to get people to take advice when they still have control over their faculties and when they have not passed beyond the point of no return.

The point of no return is impossible to classify therapeutically or psychologically; there are differences of opinion on it. I was told by the experts at the international congress that one of the certain signs that a person is becoming an alcoholic is if he does not remember the next morning what he did the night before. He should then definitely enter a clinic. That is only one example of the point of no return. We must get people before they reach that point.

I think I have answered most of the important questions that have arisen. A great many other questions that were asked have already been answered through supplementaries to questions asked in the House.

May I ask a final question? I spoke at length in regard to the position of Mallow hospital. When concluding, I asked the Minister if he was prepared to receive a deputation from the councillors in Cork in this regard. I suggested the Minister might tell us when replying. He has not told us. Will he tell us now?

Yes. As I told the Deputy, under no circumstances will I ever go in reverse in regard to the proposals in the Fitzgerald Report. I made that clear. I have said that if the health board so wish, the services and facilities as at present constituted in the Mallow Hospital can be continued. In regard to the general operation of the Fitzgerald Report, I have already told the House many times that in regard to the controversial proposals, the report of the Medical and Social Research Board will have to be examined and analysed by the regional health boards and the regional hospital boards. Before any step was taken I would receive the county advisory committee with such co-options as they desire to put on that committee. In view of this tremendous agitation in Cork and, as I believe in communication, I have already informed Deputy Cronin, Minister for Defence and the other Fianna Fáil Deputies that if it is any help and they want to discuss this with me I will receive in advance, instead of after all these other deliberations have taken place, a deputation consisting of the new north Cork county advisory health committee. If they choose to co-opt some representatives of the retention committee. I am willing to see that committee.

That will include myself. For the first time the Minister is prepared to discuss it.

But as I have said, there is not much use discussing something when I have made up my mind irrevocably on the proposition they put forward.

May I ask the Minister if, on the matter of health education, he has considered the question of education on family planning and also the question of publicity on the dangers of venereal disease and if he has looked into the question of whether posters on this problem are prohibited by law?

I am looking into the matter of venereal disease. I have nothing to add to what was stated by the Government in relation to contraception.

So that the Minister is still opposed to family planning?

I have not said that I am opposed to family planning.

Motion to refer back, by leave, withdrawn.
Vote put and agreed to.