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

Debate resumed on the following motion :
That a sum not exceeding £58,028,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of March, 1973, for the salaries and expenses of the Office of the Minister for Health (including Oifig an Ard-Chláraitheora), and certain services administered by that Office, including grants to Health Boards, miscellaneous grants and certain grants-in-aid.
—(Minister for Health).

Before Question Time I was considering some of the changes with regard to health administration and I was dealing with the establishment of various bodies. One of the points I wish to stress is that there appears to be a duplication of administration. We have set up too many committees and other organisations with the result that there will be difficulty in allocating responsibility; it will be difficult to know to whom is the doctor in any area responsible. At the moment there is confusion when patients want to consult someone in authority. I hope the Minister will deal with this matter in some detail in his reply.

Public representatives have made numerous representations regarding health measures. To me it appears that the elected representatives are being squeezed out. I shall describe the situation as it applies to the Midland Health Board. The board covers four counties—Laois, Longford, Offaly and Westmeath—and four members are appointed for each county, making a total of 16. Of the remaining 14 persons on the board, seven will be registered medical practitioners practising in the board's area, a dentist practising in the area, a registered nurse or a psychiatric nurse who is practising in the area. Three persons are appointed by the Minister and that means there are 16 public representatives. In other words, there are public representatives who will have a say and who will be answerable to the people who elected them.

In regard to the regional hospital boards, the Dublin Regional Board will have 32 members made up of four appointed by the Eastern Health Board, four by the Midland Health Board, four by the South Eastern Board and four by the North Eastern Board, a total of 16 public representatives.

Legislation adopted by the House may not be criticised.

I answered all the points raised in the Dáil and Seanad, if the Deputy cares to read the report.

Yesterday when dealing with this point, when I mentioned health boards you did not allow me to continue.

The Deputy is now dealing with regulations which have been disposed of.

I will not pursue the point further other than to say I do not think public representatives have a sufficient say. There are a few other points I wish to deal with before I conclude. I should like to refer to the care of the elderly and particularly aged people who are very seldom acutely ill but who occasionally suffer from influenza and other such ailments. There are nursing problems for them and family circumstances may be such that there is serious hardship for daughters or sons if they have to look after them. Therefore, I hope that our system of caring for the elderly will improve greatly and I should like to see accommodation made available for them in towns where they could be looked after during minor illnesses. In Offaly at the present time the county home in Tullamore is not available for such people.

There are some 40-bed hostels in Offaly. What more can I do.

There is accommodation for more than 100 people in the county home and I should like to see these beds made available as soon as possible. I hope the Minister will get in touch with the Midland Health Board in this regard. The county home in Tullamore is a very old building with stone steps and iron stairs and the sanitary facilities and toilets are outdated. The heating system is antiquated and the air conditioning is substandard. I appreciate that there are 100 beds being provided and that a home is being prepared in Birr for old people. There will also be a home provided in Edenderry. This is urgent because the standard of the home in Tullamore is one that, I am sure, the Minister would not regard as satisfactory. The problem is a pressing one.

I hope the necessary steps will be taken without delay to build the regional hospital in Tullamore. The hospital will mean a great deal to the people. The work should get under way as soon as possible. The Minister has made rapid strides in providing residential care for the mentally handicapped. I trust this good work will continue and that the backlog of 895 awaiting residential care will soon be wiped out. There have been a great many changes in our health services over the last five years. On the Minister's shoulders rests the responsibility of co-ordinating all these services. I wish him luck in his task. I hope he will be successful.

There are certain matters I should like to raise on this Estimate. They are matters affecting my constituency in particular. I come from the highest rated county in the country and our contribution to health this year is £3.19. The Minister has stated that 70 per cent of the cost will be paid by the State. That may be so, but £3.19 for a county like Mayo is beyond the capacity of the ratepayers, particularly the ratepayers in the small towns. The burden is an enormous one. One of the reasons why this situation has arisen is because we have no specialist services in our county and patients have to be transferred to hospitals in Dublin and to the regional hospital in Galway and the cost of transport creates an enormous burden on the people.

I have been told of patients who have been discharged from Dublin hospitals and who have been kept for three, four, five or six days in hospital, involving a cost of £5 or £6 a day maintenance. This should not happen. This merely creates another burden. In my county 50 per cent of the people have medical cards, which means that they are in the lower income group. Complaints are made about delays in getting patients in this particular group into hospital. I heard a Deputy—he is also a councillor in Mayo—state that a man had been dead for six months when notification arrived that he was to go to a Dublin hospital. Another man—God rest his soul—was awaiting transport to a Dublin hospital for three months. Because he had a medical card he was deprived of immediate hospitalisation. Three months after he had returned from a Dublin hospital, in which he had been operated on, he got word saying that a bed was available for him in a Dublin hospital.

We are constantly being told that the poorer sections in our community are being looked after. I state openly here now that these people are not being looked after. It is the man who can put his hand in his pocket who is looked after. I know this from personal experience as a member of a local authority for close on 14 years. Thank God, that the people of Mayo gave me the opportunity of coming in here and making these statements. They are facts. They cannot be controverted. If I go to my local doctor and he diagnoses some serious illness requiring an operation all he has to do is pick up the phone, ring a Dublin hospital and there will be a bed available in two or three days or, perhaps, that very night. If a medical card holder finds himself in the same position, the doctor must put him through Mayo County Council, put him through all the red tape of officialdom and then the unfortunate patient must wait, maybe for months, before he will be notified that there is a bed available for him. Despite this we are told that there is a general hospital service for all. If what I have said is not discrimination against the lower income group I do not know what it is.

We now have the Western Health Board. As a local representative I do not believe in handing over my authority locally to a provincial board. In fairness, I must say that the officials on the Western Health Board have been most courteous and helpful and have done everything to accommodate me. The county councillors know all the problems within the county. What we will get from the Western Health Board at the end of the year is a demand for a sum of money the expenditure of which has not been decided by the councillors. A member of that board spoke at a meeting in Castlebar—he belongs to the Minister's party—and he said openly that as a member of the Western Health Board he had no say whatever in appointments. I would agree that the members of the board should get all the technical advice possible, but their authority to make appointments should not be taken from them. They are the representatives of the people. The day that happens will be a sad day for this country.

We have a county hospital in Castlebar which was to be raised to the status of a general hospital. This decision was taken by the Minister and the Department at least three years ago, and nothing has happened since. There are hundreds of young girls in County Mayo who are trying to get into the various hospitals as student nurses. The Minister did not mention a general hospital for Castlebar with a training centre for nurses in his Estimate statement. Looking at all the Dublin hospitals listed here and the amount of money allocated to them. I wonder is the Minister or his Department interested in the West of Ireland any more? At least 50 girls a year come to me and ask me to make representations to get them into training hospitals. If the county hospital in Castlebar were raised to the status of a general hospital we could train 30 nurses a year. This would be an asset to County Mayo in general. Our girls have to go to Dublin for training. If there is no accommodation in the hospitals they have to live in flats.

We have transferred many staff from County Mayo to Galway and we are building up the regional hospital there. I fully agree that we must have all the specialised services as near to each other as possible within the region, but the people of the county are not gaining in any way. A new county home is being built in Castlebar. I think the second or third wing is under construction at the moment. It should not be called a county home. The Minister should rule out that name. We do not believe in workhouses or county homes any more.

The health board can call it anything they like.

In several counties there are county and general hospitals. The Minister should see to it that in future when county homes are being provided they are extensions to the county hospital or the general hospital. They could be used as geriatric sections and they should no longer be called county homes or workhouses as they were under the old British system. We do not want to degrade our people. This would upgrade them and it would not create a difference between nursing homes, county homes and county hospitals. In building a 350-bed county home at a cost of £1½ million of the taxpayers' money we are not creating one extra bed for the people within the county. We are just replacing the number of beds that were in the old hospital.

We are also building two 40-bed hospitals in County Mayo. Did the Deputy not know that?

It is recommended that they should be built.

They will.

We have been building the county home for five to seven years and it is not yet completed. I have studied the Minister's community homes.

One 40-bed hospital could be built this year.

Has not the Minister decided to move 200 patients who are not classed as mental patients from the mental hospital in Castlebar to the new county home? If that is the Minister's approach, how has he created one extra bed? By building three community homes in County Mayo how is he creating one extra bed?

I must compliment the matron of the county hospital in Castlebar and the matrons of the district hospitals in Swinford and Ballina. People, including doctors, come to me because they cannot get a patient into those places. There is no room for them. As was stated before: "There is no room in the inn." I would suggest that the district hospital in Swinford should get 15 to 20 beds extra at least. A community of nuns bought Castlemacgarrett House and set up a geriatric home. There are something in the region of 60 patients there at the moment. We have the St. John of God hospital in Ballinrobe also catering for patients. The Minister tries to tell me that he has created extra accommodation. The effect of his community centres is to transfer—and I am 100 per cent with this—people who are not mentally ill but are in mental hospitals, to other hospitals. He has stated, and it has been stated by the Western Health Board, that one community home will be built in Castlebar or in Westport this year. We are expecting another community home to be built in Claremorris but I doubt if it ever will be built. There is a district hospital in Ballina and I hope there will be a community home there. Kiltimagh had a cottage hospital and the people there are very anxious to have it opened if the Minister will give them help, so that patients could be attended to. It is a sad day for the country when I, as a public representative, or a doctor attending a patient, cannot get a patient into any of these places. There is no room. This is the position in County Mayo.

I hope the Mayo County Advisory Committee will present a report to the Western Health Board reinforcing everything the Deputy has said.

I have presented my case to the Minister, which should be a lot stronger. It is factual. I have put my case across the floor of the House, which is honest.

I am very glad the Deputy has done that.

I will be on record. It is an honest statement.

The Deputy does realise that it is very important that the county advisory committee present this case to the Western Health Board because they have to make the decision?

Doctors come to me and to other public representatives. I feel embarrassed. The matron in charge of the hospital is embarrassed. The matrons in the hospitals have done everything possible to accommodate patients and they feel embarrassed when I, as a public representative, have to apply to get a place for a patient.

Now I come to a very crucial matter. There is a mental handicap association in County Mayo. First, I must compliment the local organisation, the county mental handicap association, who collected last year approximately £28,000 in County Mayo towards the provision of accommodation for mentally handicapped children. Many parents come to me, sometimes on the verge of a nervous breakdown, because there is no accommodation for their children. In some cases they cannot relax their supervision of these children for fear they would injure the baby in the pram or do some other damage. Immense problems are created for these parents. The provision of accommodation for mentally handicapped children should be a first priority. I have known cases where children could not be placed in a suitable school until they were 16 years of age. We were told that accommodation would be provided. It is the Department of Health, the people and the Government who were responsible for this. These children and their parents should have received first priority.

I refer the Minister to a question I raised in the Dáil which was taken up by the Mayo Mental Handicap Assocation, in these terms:

My association have noted reports that the Minister for Health, replying to a question from Mr. Martin Finn, stated recently in the Dáil that 33 children in County Mayo were awaiting residential care in special centres for the mentally handicapped on the 31st March last.

That was 1970. I continue the quotation:

With due deference and respect to the Minister for Health the Association would like to comment on the above reported statement.

Quite an intensive campaign has been mounted within this county to provide services for what we know to be a reasonable estimated number of mentally handicapped children of all categories, mild, moderate and severe.

To the best of our knowledge in the Association this figure is in the region of 700 to 800. In fairness to all who have subscribed so generously this year within the county, to this worthy cause, and in fairness to the many collectors who will have to carry out this organised collection for the next seven years, we feel justified in pointing out the actual position as it stands within the county today.

I wonder where did the Minister for Health get his information.

Will the Deputy give the source of the quotation?

It says:

The Minister's reported statement could be misinterpreted and, hence, this statement from the Association. To our knowledge more than 100 moderately and severely mentally handicapped children alone are now awaiting placement in suitable residential centres.

What the Chair is asking is the source of the quotation.

I am taking this from the Western People. The letter was signed by Michael Doherty, MPSI, honorary public relations officer.

I have the greatest respect for the Minister and I say in all sincerity that he is the most upright man I have seen across the House since I became a Member of the Dáil a few years ago. I cannot understand and the mental handicap association could not understand how the Minister could give the figure he gave. This figure needs to be checked out. If the Minister has any authority from which he is taking the figure, he should check again when he is answering a question, the reply to which can be challenged by people who are doing their utmost in a voluntary capacity to provide accommodation for mentally handicapped children, as they have done in Castlebar. Two schools have been opened. When the Minister makes statements he should make certain that the figures he gives are correct. I am sorry to have to make this statement. The Minister's statement was taken up by the association in County Mayo.

There is progress in the provision of schools for mentally handicapped children in Ballina. This is welcome. I could submit several names to the Minister from County Mayo and ask him if he could place those children. Is there accommodation available for them? If I submit those names, can the Minister give a guarantee that they will be placed?

I have explained the position in full to the House. I have told the House that there is a waiting list and it will take three years to complete the 1,400 places. The money is provided but the planning and building of the units and the training of staff will take two or three years. The staff ratio is about one staff to three patients. The religious organisations are developing the plans, they are commencing to train staff. It is guaranteed each year to provide all the money required for severely and moderately handicapped children in residential places. However, the building, planning, site development and training of staff will take a considerable time. I have been frank about this matter to the House.

Can the Minister state why the association dealing with mentally handicapped people in Mayo have had to send two representatives to America to collect funds to accommodate the children in Mayo?

There is a considerable amount of voluntary effort also involved.

In Mayo a considerable amount of voluntary effort is put into it and every householder in our county pays £1 yearly for this purpose. The Minister has said that sufficient money is available; if this is so, why should our people contribute?

I was assuming everybody was delighted to contribute some funds—they are in other counties.

We are delighted to help in this matter and we have made a tremendous effort. We are prepared to carry on the work.

That is happening everywhere.

I am glad the Minister has made it clear that the children cannot be accommodated for three years. The choice of doctor scheme will be introduced into the Western Health Board area next October and this is to be welcomed. It was the most important decision the Minister has made and it has been urged by Fine Gael for many years. If a person has not confidence in his doctor, this cannot be satisfactory. Up to now it has been the lower income group which have suffered because they did not have a choice of doctor. From now onwards every family, regardless of their status, can have their family doctor and will not be forced to register with any other doctor. This decision will be welcomed particularly by the lower income group.

I must compliment the doctors, whether in private practice or in dispensary work, and in particular the doctors in Castlebar Hospital. They have done tremendous work. However, patients who hold medical cards are put on a waiting list for three to four months. If they find it necessary to go to Dublin for treatment there is an even longer delay. In desperation many of them consult their own family doctor and beg him to get them admitted into a Dublin hospital. Strange as it may seem, in many cases the doctor will succeed in getting the patient admitted within a matter of a few days. Frequently the patients are presented with large hospital bills which they find impossible to pay.

I listened to the speech made by Deputy O.J. Flanagan last night and I was filled with admiration. He said that a medical cardholder who went to Dublin for an operation had received a letter from the specialist who operated on him. The specialist stated that he was only getting 1s 2d per hour to operate on the patient. This would apply to any hospital where the patient was a medical cardholder. This statement was made by Deputy Flanagan when the Minister was present in the House and it was not contradicted.

We should pay our specialists and surgeons a decent salary so that they may treat the poor person on the same basis as they would the rich man. Regardless of what the Minister or his Department may think, the whole transaction is geared against the lower income group. The specialists who are doing a tremendous job have my greatest respect but, unfortunately, they are not being treated well by the Department. They are entitled to a decent salary because they are doing a tremendous amount of work. To give them 1s. 2d. per hour or 5s. per operation is not treating them in the right way. Deputy Flanagan made this statement and it was not contradicted by the Minister.

I can assure the Deputy that there is more to it than that. The story was not complete. County surgeons are paid between £6,000 and £7,000 a year.

It does not seem to be according to trade union standards to pay a surgeon 1s. 2d. per hour.

That statement was made; the letter was written by a reputable specialist and was read out by Deputy Flanagan.

I do not take seriously anything of that kind stated by Deputy Flanagan. I take seriously what the Deputy says.

If it is true, surely it is about time it was looked at?

The Deputy should get the Mayo Advisory Committee to inquire into the allegation that the medical card group are grossly neglected in regard to hospital treatment. I have had very few complaints of this kind from any part of the country and I do not think any of the Deputy's party made such an allegation.

They had not the courage, but I have. I never say anything behind anyone's back and I have the responsible Minister here now and I should like to bring these things to his attention. Do not think I am casting any reflection on the doctors or nurses. I am speaking about the system and I am saying that medical card holders who have to go to Dublin for treatment are left on a waiting list. The Minister must agree that they do not get the same service as the man who can pull out his cheque book.

It is the fault of somebody in the Western Health Board if such people are not receiving at least adequate attention. The Deputy should list the names and, through the advisory committee, bring this matter to the attention of the Western Health Board and make a real row about it.

As a member of the Minister's party said, we have no say in it.

I have created a pressure group with all the modern means of creating a row, and so long as it is not an exaggerated statement by a head case it is the duty of the Mayo advisory committee to submit it to the Western Health Board.

They have not got into top gear yet.

I know that. I am only drawing it to the Deputy's attention.

I am making honest statements and drawing the Minister's attention to the position. Three or four years ago we added a new wing to the mental hospital in Castlebar but it has not been opened. Something went wrong. A vast amount of money was paid out and I do not know what the position is.

The defect there is being remedied.

At what cost?

I do not know the financial arrangement. It is a matter between the contractor and the health board.

This was to be a 200-bed unit and it has been there for four years. I should like to know what went wrong. It is a laugh in County Mayo. Some time ago there was a general decision in the Department to appoint community mental nurses who would go out to visit patients who had been released from mental hospitals. Six of those candidates qualified in County Mayo but only two have been called. They do tremendous work among those people. I wonder if the Minister is to establish another panel with another interview for the four who were not called. It is a hardship on those young men, apart altogether from the fact that their services are badly needed throughout County Mayo.

I do not allocate posts. The Deputy should inquire from the Western Health Board.

The regulations were made by the Department, not by the board. It was a decision by the Department and I do not want to be referred back to the board. The interview was held one and a half years ago.

We just sanction the total number of nurses, the rest is a matter for the health board and the Deputy should find out from them why those men were not called.

There is a serious shortage of beds for geriatrics in County Mayo and I suggest that the health board should make allocation towards keeping those people at home. Last week a woman came to me. Her next door neighbour who was drawing a blind pension was not well. He had gone to Castlebar hospital but stayed there only two days. When he came back he found that his old thatched house had fallen in and she, in charity, looked after him. Is that woman entitled to an allocation? If the Minister provided a special allowance for such people, manly old people could be cared for in that way without having to be put into county homes.

Earlier today I was in touch with the Department about the new social insurance scheme. I understand that if one comes under this scheme and one fails to pay the contribution of £7 one is liable to prosecution. There are farmers in my constituency who know nothing about this scheme. They did not see the notices in the newspapers and they were not circularised. Are they liable to prosecution if they are not insured? They have not applied because they knew nothing about the scheme.

They will not be prosecuted then.

I was told by the Department today they could be prosecuted. They are quite innocent and I suggest that steps should be taken by the Department to remedy the position.

It is the Western Health Board which is responsible, not my Department. The board may have fallen down on communication.

The Western Health Board is responsible for this insurance?

I take it the Deputy is dealing now with the health contribution scheme. It is not insurance. It is the health contribution scheme.

I am talking about the £7 contribution.

It is the Western Health Board which collects the contributions. It is a matter for the Western Health Board. The position can be put right by communicating with the Western Health Board. Evidently communication has broken down.

It certainly has. Every farmer should have been notified. It would be very serious if a man were prosecuted because he had not paid.

They should apply for medical cards. Then they would not have to pay the £7.

I thank the Minister for clarifying the position.

The activities of this Department are many, indeed, many in number and diverse in character. It would, I suppose, be literally impossible for the Minister to touch on all the activities of his Department in his opening speech and there was one particular field that was omitted. I should like to draw the Minister's attention to it now. It is the assistance his Department may give to the unmarried mother. About two years ago the Minister attended the national conference at Kilkenny where the problem was discussed. The conference was composed of persons from the various health authorities and from the Department, of social workers, who had a particular professional interest in the problem, and of representatives of the Churches.

The implications and the dimensions of the problem were discussed. It was pretty clear from the discussion that the assistance available to the unmarried mother in her sad predicament was virtually nil. The conference gave an impetus towards something being done and I subsequently asked the Minister here what assistance or what steps he would take to alleviate the problem exposed at that conference. Speaking from recollection, I think the Minister indicated that, when something concrete came out of that conference, he would be glad to give practical assistance.

I am pleased to report to the Minister now that something very practical has come out of that conference in the form of an organisation called "Ally". The organisation has been in existence for some years and it has been doing a tremendous amount of beneficial work for unmarried mothers. The basis on which the organisation works is that it recruits, if that is the right word, families who are prepared to accept into their homes single girls who are pregnant and maintain them as members of the households right through until arrangements for adoption are made, if such arrangements are desired by the mother.

Progress reported; Committee to sit again.
The Dáil adjourned at 5 p.m. until 3 p.m. on Tuesday, 4th July, 1972.