When speaking on this Estimate last night I commented that, while we may be critical of what the Government are doing, we are all in favour of trying to improve the health services. This Estimate is for a substantial sum of money, more than £58 million. While the Minister has been very courteous in carrying out his duties, he and the Government should have made an effort to level off our health services with those in operation in the Six Counties, that is, if we are serious about the re-unification of the country. That is an aspect on which I would like the Minister to comment when he is replying. If we do not make an effort in this respect what will happen is that, when unity is brought about eventually, we will have to try to bring our scale of services to the level of those in the North and if this is not done gradually a lot of extra money will be required at the one time.
This brings me to the question of the impost of the health services on rates. This year the Government gave a little extra towards payment of the health services in order to alleviate the rates to some extent but, unfortunately, the rates have been increasing each year and the health services have played a large part in these increases. Of course, those who are well never think of the day when they might be ill and, consequently, they complain when they are asked to contribute towards the health services. The huge increases recently in hospital charges has made everybody realise that there must be found some other way of financing the health services. Although, as the Minister pointed out, the State this year has subsidised the health services to a greater degree than before, the increase in the hospital charges has created a situation whereby there will be a very heavy deficit carried forward to next year. This shows once again, if the evidence is needed that a wrong system of servicing the health charges is being used.
Unfortunately, the new arrangement which the Government introduced last October for servicing portion of the health charges appears to be backfiring in certain areas. I am referring to the extra 15p per week which is being paid by insured workers who are not in possession of a medical card, to people in the self-employed category who are paying £7 a year, and to old age pensioners who, for some extraordinary reason, have been ruled by the Government as not eligible for free service even though they are eligible for everything else which social welfare insurance buys. When the new arrangement was made they thought they could go into a public ward in a hospital and would not be responsible for any payment. Many of them are now finding that this is not so. Many of them are finding that because of a misinterpretation or misapplication of the rules they are still required to pay for hospital treatment.
We get letters from health boards, as I did no later than today. The CEO writes and says: "No arrangements have been made with this hospital". I assume that means that the hospital to which the patient has gone is not within the area covered by the health board. Surely something must be wrong. I tried to explain this yesterday evening and I will try to make it a little clearer today because some people seem to have misunderstood what I said.
If patients go to a hospital which is a normal hospital for the treatment of their ailment I can see no reason why the health board should refuse to pay their hospital bill if they are (a) in possession of a medical card, (b) paying 15p per week, or (c) paying £7 per year as self-employed persons. Possibly the fault lies with the local health board but I should imagine that, in most cases, the fault lies with the instructions given by the Department of Health which do not make it clear enough to the officers in charge locally that in such cases they should pay for the hospital treatment.
The position in regard to outpatients is similar. Surely it is ludicrous that poor people who would normally be entitled to free medical treatment, and who go as outpatients to a hospital, should be asked to pay for some of the things which they require as outpatients. Surely it is wrong that after a number of months they should receive a substantial bill from the hospital, even though they are paying for that treatment under another heading. This matter should be clarified by the Department.
I believe that the improvement of the health services is the object of everybody, and particularly of the Minister and his Department. If something which should be allowed is not being allowed this should receive priority over everything else. Possibly in most cases the mix-up occurs because some people are being extra careful and during the teething troubles they do not want to make any mistake at local level. The Minister's Department should ensure that they know explicitly what people are entitled to. That should be explained, particularly when the hospital treatment given may be costing less in the hospital to which they go than in a hospital within their own area, or their own region. This must be dealt with as a matter of urgency. There appears to be a tendency now to charge people for appliances and specialist services even though up to this they were entitled to get them free. Something should be done to have these matters dealt with.
Like a number of other speakers, I regret that the waiting list for places in schools or homes for mental defectives appears to be terribly long. When Mr. MacEntee was Minister for Health some years ago he got the wonderful idea of acquiring a number of old buildings which would be suitable for use for this purpose. He then found that there were no trained personnel. With a great flourish of trumpets the Department decided that they would set up schools to train people to look after mentally defective children. Unfortunately, only about ten people were trained in the first year and the idea was conveniently forgotten, apparently, because the list has not been shortened very much. All of us must know of mentally defective people who by the time they reached their place on the waiting list had outgrown the child they were when the application was first made. This is rather a pity.
Because of comments made by various people inside and outside the House it would be unfair if I did not pay tribute, from my own experience, to the way in which members of the religious orders have been dealing with those children. They are doing a tremendous job and the thanks of the people of this country must go to them. I say this particularly because there seems to be a tendency at present to knock some of the religious orders. I do not think that is a good idea. They are only human. They are like ourselves. They can make mistakes and they can be greedy and want things to which they are not entitled. In general, members of religious orders in the hospital services and, indeed, all lay and religious in hospital services, are doing a tremendous job for which we cannot thank them enough. We should at least record that in this House.
I come now to the question of dental care. I was always interested in the arguments made by successive Ministers for Health that, while it was important to look after the dental health of children, it was not so important to do the same for adults mainly because of the fact that (a) there was a shortage of money and (b) there was a shortage of dentists. I believe that either the payments made to those engaged as dentists are not enough, or the system being used is not correct. I am told that in Britain where there is a fee for service payment it is possible for a dentist to attend to six, eight or ten patients in a session, whereas here, apparently, in most, if not all, cases the system is that a certain number of patients are rostered, say, six, over a two hour period, and if only three turn up three are attended to and that is it.
An effort should be made to speed up dental treatment for adults. I will refer to children in a moment. Some arrangement should be made with dentists who are not in the employment of a local authority so that they could deal with the bad cases in particular. I cannot agree with any Minister who claims that the father of a family who is out of work, perhaps, once or twice a month due to—I nearly said teething trouble—dental problems is not entitled to receive priority. I do not agree with Ministers who say that this is not important. Dental care is very important for fathers and mothers of families whose general health deteriorates because they do not receive the dental care they need and who are unable to pay for the care they require. An effort should be made to supply this service to them.
With regard to school care, I think something has gone wrong in most counties. Some years ago mobile units went around to the schools. An effort was made at that time to give school children a medical examination once every two years or so. It now appears that the most we can expect is that a child in a primary school will get a medical examination under the local authority once in his school life. It appears to be extremely difficult to have dental care given to children who need it. There are many children on the waiting list and these have to wait a long time indeed before they are called in for attention. If they are really serious cases the doctor will use a little trick, as somebody said here last night, and have the children taken into hospital for something else so that they can get the requisite dental care.
We are not treating this matter seriously. An effort should be made to resolve the present unsatisfactory situation. It all goes back to the number of dentists available. I see no reason why a young dentist should have to go to England or anywhere else to work. If these young dentists were adequately remunerated here they would stay here. The key to the problem is the amount they can earn. All of us like to earn as much as we can, within reason, and steps should be taken immediately to ensure that these young dentists can earn a reasonable income here.
Drink has been in the news in the last few days. There have been comments from different people about the excessive use of alcohol. I am myself a pioneer but I know there are many people inside and outside this House who can drink in moderation. There are also people who say that drink is bad. These simply do not know the facts of life. Unfortunately there are people who cannot drink in moderation and a better effort will have to be made in the future to deal with these. The Pioneer Association will accept only those who want to give up drink altogether. They will allow a small number of lapses. One cannot join this week and leave again next week. That would be tantamount to the case of the man who said that he had no difficulty in giving up cigarettes; he had given them up twice a week for years. Alcoholics Anonymous are prepared to accept people who lapse.
Surely the State should be able to give more help in breaking people of this vice. Excessive drinking is a vice. I was discussing this matter with a hotelier recently and he pointed out a rather interesting feature of the situation. In his hotel bar there was a number of ordinary people, middle aged and more than middle aged; they were sitting over a glass of stout, a glass of ale or, perhaps, a whiskey. The youngsters were all drinking brandy just as quickly as they could. I asked him why this was happening and he told me it was a status symbol: the others could not afford to pay for brandy and so the young people felt that drinking brandy made them superior to everybody else. These should be educated and taught that, while drinking in moderation is all right, it is not all right to gulp down glass after glass of brandy and then attempt to drive a motor vehicle on the public road.
I am glad that the State does appear to have done something about drugs. Two or three years ago scares about drugs being peddled were quite common. We do not hear so much about that now. An effort has been made to prevent the theft of drugs from dispensaries. It was criminal to leave drugs so easily accessible that they could be taken by someone breaking a window or forcing the lock of a door. I mentioned last year a dispensary in which the doctor was not satisfied with the kind of door put in by the local authority and, because he was not satisfied, he did not lock the door; anyone could walk in and take away freely available drugs.
The reason why a better effort is not being made by the State to curb cigarette smoking is because of the revenue collected on cigarettes. That is also true in the case of drink. This revenue is very important in the running of the State and we appear to be in a quandary as to whether or not we should allow the situation to continue in order that the revenue can be collected or whether we should make an effort to prevent smoking and curb excessive drinking and do without the revenue. Great numbers of people are employed in the tobacco industry. Is it not a pity that people have to be employed on that kind of thing in a country like this? Surely an effort should be made to find some cigarette which is not harmful to health.
I would ask the Minister to have another look at his choice of doctor scheme. This applies only to those who have medical cards. Those paying the 15p per week thought they were entitled to a choice of doctor; they are, provided they pay him. Those who have a choice of doctor should have a wider choice. We predicted that when the dispensary system was done away with we would have areas in which there would be no doctor because no doctor will live in an area in which he cannot make a living. The result is it is extremely difficult to get a choice of doctor because people are on the edge of two different regions and some doctors are unaware that they can apply, if they so wish, to be included in a neighbouring region. People who had been getting a doctor living within half a mile of them now find he is no longer available because he is not on the list. Would the Minister ensure that if a doctor comes along, who is not already included in the list but who is anxious to participate in the scheme, he will be given an opportunity of doing so? If that is not done there are people who will have no choice of doctor. Some may have no doctor available at all and they will be in a worse position than they were before the introduction of the scheme.
I thank the Minister and his officials for the courtesy they have accorded to me on numerous occasions and for their co-operation. Will the Minister tell me when he comes to reply who owns the county infirmary in Navan and what will its future be?
