I am very pleased to speak on this Estimate, which gives us the opportunity of pointing out the fundamental differences between our policies and the policy pursued by the Coalition. In his speech the Minister said that he had determined some major priorities. Among those priorities he lists the provision of free hospital care for all. This is a socialistic pipedream catering for a concept rather than for the nation.
In the face of last year's difficulties he must now agree that this is neither attainable nor desirable. To pursue this any further can only be termed ministerial madness. Perhaps this is not entirely the Minister's fault. Perhaps some of the blame can be laid at the door of the officials in his Department but that is hardly likely. In my view this blame can only rest on the Minister because this is one of his priorities and I am sure his officials have been told to bring it about, if possible.
It is hardly necessary to point out the even tenor and the results obtained during the term of office of his predecessor and the good relations which existed at that time between the nursing staff and all involved in medicine and the Department. Much of that has been lost. Needless to say much of the fault of the present impasse must rest with the Minister. We must compare the certainty and guidelines laid down by the late Erskine Childers, the setting up of the health boards and the fact that people knew where they were going and how they would get there, with the uncertainty that exists today.
I do not wish to belabour the Minister personally for I have always found him approachable, human and helpful. The policy at present pursued in the face of difficulties, the frightful expense it would involve and the experience gained from other countries, where a free-for-all medical scheme is available, should be a salutary lesson for any Minister. We should pursue not what other countries have tried and failed but what will suit the needs and pockets of this country.
We realise that there is a limit to the amount of money available and hope that the best possible use will be made of it. Maybe the services we are now giving to our GMS cardholders are not all we would like but the people who are not so well off and those just outside the limit of the GMS card who suffer hardship and anxiety trying to make provision for the rainy day from scarce resources are the people we should help first. Why should we provide free hospital treatment for even the very rich, if they do not want it? The Government's priorities are seen to be wrong here. When I wished to point out to people the difference between the Government and Fianna Fáil, this is one of the items I point to as a glaring example of the defects in the Government's priorities. I am positive the Irish people feel the same.
Deputy Haughey had a Private Members' motion and many Deputies spoke on it. I am confident that the pleas we made then had the support of the Irish people in this matter. When people's GMS cards come up for review, in many cases they are cancelled and when the matter is brought to the notice of public representatives and when pleas are made to have the thing re-examined, it is frequently found that card holders have been on short time and have not the same earning power as they had, and they get their cards back. The point is that the cards should never have been cancelled.
According to the Eastern Health Board's guidelines, even agricultural labourers and county council road workers could be left out. I am sure this is something nobody intended when the free GMS scheme was introduced. It is possible that a husband, wife and child, with total earnings of not more than £27 per week, would find themselves outside the category. All will agree that £27 does not go very far. It is, therefore, essential that the Minister would extend the scope of the service. I could quote many examples of hardship. The hallmark of a good Government is sometimes their willingness to admit a mistake or an error in judgment and rectify it. They should be prepared to admit that a policy they were pursuing was not right and they would correct it.
There is another frightful anomaly to which I wish to draw attention. It is the gap between national school leavers—children are now leaving national schools at 12 years—and post-primary pupils at the age of 16 in the matter of free medical and dental treatment. Children leaving the national school at 12 cease to be qualified and do not again qualify until they are 16 years, when they are able to get medical cards. Many pupils between the ages of 12 and 16 years are denied treatment, particularly dental, at a time in their young lives when they are most vulnerable and when caries are most rampant. It is madness that such an anomaly should exist.
Since the arrival of free post-primary education and automatic blanket promotion in national schools, the age of primary leaving has been reduced by at least two years. Pupils who formerly would have stayed in national schools until 13½ or 14 years now leave those schools for secondary and vocational courses as young as 12 years and sometimes even 11. At that age they are most vulnerable, as I said earlier, and because of this hiatus between the ages of 12 and 16 they are denied dental examination and treatment—they are cut off from such services for four years. This could damage their health in the future. Dentists and others to whom I have spoken feel that this four years of neglect can undermine the health of our children, that the damage done in those years can never be repaired. I raised this anomaly by way of parliamentary question and pointed out that this gap should be bridged immediately.
While on the subject of dentists, the Minister will have to look into the scarcity of dentists in the public service. It is very difficult to recruit dentists and because of that, dental examinations of children which should be held at least yearly in the national schools are sometimes not held at all until after many children have left those schools. There is, therefore, no preventive treatment for those children, the only work apparently being carried out is extractions. It is essential that an all-out effort be made to recruit dentists into the public service. The dental schools are turning out a sufficient number of dentists but many of them go abroad for experience. It is hard to blame them because any town to which a young dentist might go to seek to earn a living seems to be full of people in private practice.
In County Kildare there are 15,000 national school children and it is estimated that six dental surgeons would be needed to give them adequate service. In fact, we have one dental officer for the county and three assistants. There are 15,000 medical card holders in the county and as well there are 1,000 students from Maynooth University who have now been included in the dental programme. In other words, four dental officers are endeavouring to take care of 31,000 people when 12 would be needed. The result is that children are being neglected. If children are to be looked after properly, extra dental surgeons will have to be appointed and the conditions will have to be made right for them. If it were the case that electricians, plumbers or stenographers were not available we would get them from outside the country, as we have done, if there was special need. It is just because this is a soft area, an area which is not of great political consequence, that the matter is being neglected. If a similar situation existed in any other branch of the public service or private service there would be an outcry. The need exists for more dentists. The present conditions are not conducive to attracting dentists into the public service. The idea that he would be able only to touch the tip of the iceberg and would never be able to get down to fundamentals would be intolerable to anyone who wished to do his job well and to fulfil himself in it.
Anyone who enlists as a dentist in the public service must feel a frightful sense of frustration. No dentist would like to spend his life in such frustrating circumstances, where he would have to confine himself to doing extractions and to dealing with cases that should never have been allowed to deteriorate to the extent that they have, never having any hope of carrying out preventive treatment because of the huge waiting list for treatment. I hope the Minister will take note of what I have said in regard to this matter. It is time that a change was brought about in the dental service.
I am pleased to note that the Minister has taken notice of a recommendation from the recent IMA seminar in Waterford to the effect that the Dentists Act, 1929, be amended to provide for the use of trained dental auxiliaries in community dentistry. The Minister should adopt this suggestion. Trained auxiliaries are employed in the dental service in England and New Zealand. Auxiliaries would be trained to apply procedures which would reduce the incidence of dental decay. This is a very important aspect. In view of the unsatisfactory position in regard to the dental service and the shortage of dentists, I hope the Minister will ensure that this amending legislation will be introduced. The usefulness of dental auxiliaries has been proved in those countries where they are employed. Their employment here would mean that there would be more personnel helping to prevent tooth decay.
The Minister stressed that one of his priorities is the training of handicapped persons for employment. I am glad that he is aware of the problem. Many people have become increasingly aware of it within the last few years. I would hope that the Minister would lay great stress on the employment of the handicapped. His priority should be altered somewhat to include employment as well as training. It is a good thing to train handicapped persons for employment but it is vital that when they are trained they would be placed in jobs. My experience is that it is not easy for handicapped persons to secure employment. I quoted some time ago the case of a boy who was blind from birth and who had passed the Leaving Certificate examination, which must have involved very great work. Because the Department of Posts and Telegraphs had changed their switchboard system from bells to lights it was impossible for that boy to obtain a position as telephonist in that Department. As a result, that young boy was very frustrated. He had to wait a long time before getting a job.
Government Departments should give the lead in this matter. I am not blaming the Minister but it would appear that Government Departments have reduced the number of jobs available to handicapped persons. It might be necessary to introduce legislation which would make it obligatory that employers would employ a percentage of handicapped persons. This may not be the best time to make that suggestion in view of the current high rate of unemployment. The idea did seem more sensible when we were in power. This is an idea that may have to be shelved but it should be kept in mind when the economy is in a better position.
I should like to compliment the voluntary bodies who do such wonderful work for handicapped persons. The Rehabilitation Institute have a school in Naas where they train persons in upholstery and other work. The very fine training that is given represents a new lease of life to the handicapped persons and a sense of achievement. Without this training their lives would be dull and aimless.
I should like also to compliment AnCO on the progress they are making. A great deal more needs to be done. In one week recently representations were made to me on behalf of two boys in their late teens each of whom had lost an eye and each of whom could not get employment in either of the factories in the town because of the insurance requirements. We got in touch with AnCO on their behalf. The position must be improved. There should be more placement officers and other personnel to meet handicapped persons and to help to solve their difficulties.
According to the report on the handicapped there are 100,000 adults who have long-term physical or mental handicap of whom 15,000 might benefit from preparation and training for work. It is our long-term duty to identify these persons and then to train them in order to maximise their potential so that they could obtain employment. The facilities at present available are not adequate to deal with the problem as we would like it to be dealt with.
There is one matter in connection with the training of the handicapped which I have raised with the Department and with the Eastern Health Board but did not get a satisfactory answer. It concerns boys who travel to the workshop at St. Raphael's Celbridge. Excellent training is given at St. Raphael's. The boys travel from different parts of the city. Bus fares eat up the small allowance they get. The allowance is not given as payment for what they do but possibly to give them some sense of independence. In some cases the journey to Celbridge involves taking three buses. I would ask the Minister to interest himself in this matter and to assure me that these handicapped persons who are doing their best within their limitations will be recompensed for it and that the allowance they get will not be exhausted by way of bus fares to this special school.
The misuse of drugs is a problem that has not as yet affected us to the extent that it has affected other countries. Please God, it never will. I had contact during the year with the Eastern Health Board with regard to a request for a lecture on drugs to be given in Kildare town to a group of youth leaders and which would be open the the public. The attitude of the Department was that they would give lectures only to certain individuals, leaders, adults preferably, rather than young persons. Perhaps that attitude is the correct one. One of the recommendations in the report of the sub-committee that advised on the Misuse of Drugs Bill was that persons charged with illegal possession of drugs, peddlers or pushers, would be brought to trial speedily and dealt with within a specific time. I hope this will be pursued and that very stern measures will be adopted against these people. There is also provision that empowers the pharmaceutical society to inspect premises and appropriate records of all their members and any substances or drugs stored in their premises. I would agree that that is a very good provision, although I have heard that the other provisions have not met with unanimous approval when discussed at our local health board meeting.
There is a lot of verbiage and statistics in the Minister's speech indicating that he was providing more money this year. He informed us there would be no cut-back either in services or expenditure in real terms in relation to last year. If one pursued this, one would probably find it was statistically and clinically correct, but the reality is that the Minister has quoted many figures in order to bamboozle people. There is no new capital expenditure except to a very minor extent. During a discussion recently at our Eastern Health Board branch meeting we were informed that a very limited capital grant for the present financial year had been given and that no capital development in any of the hospitals in Kildare was envisaged this year.
We pointed out that we were dissatisfied with this lack of provision for capital development because there is a serious shortage of beds in St. Vincent's Hospital in Athy. We had asked some time ago that a geriatric unit be added to the county hospital in Naas. These two items are closely connected because, unfortunately, our county, which has so many main roads straddling it, has accident cases brought to the hospital in Naas at weekends out of proportion, I am sure, to its size as compared with any other county in Ireland. This geriatric unit we have looked for and which the county physician pointed out was so necessary will now have to be shelved. We had all the other facilities of staff, cooking and so forth. All we wanted was a building with beds in it to cater for geriatric patients, which would relieve the pressure on the hospital itself and also help to relieve the pressure on St Vincent's in Athy. I wish to place on record that we in Kildare are very disturbed that our efforts to improve the services there have been shelved.
I should like to pay tribute to our ambulance service in the county. They have always done their work efficiently and do it even more efficiently now as a result of the installation of the radio telephone communication system. We have many voluntary workers in Maynooth and other places that deal with all calls expeditiously and efficiently.
The greatest resource we have is the amount of voluntary effort available to the health services. I wish to quote what the Minister says at column 46, volume 281 of the Official Report of 20th May, 1975:
The Exchequer is now, therefore, almost the exclusive source of funds for our health services. This situation has been brought about within a very short period of time, due mainly to the need to remove health charges from the rates on grounds of equity. If we add to this the fact that health services, because of their labour-intensive nature among other factors, are particularly prone to rapid cost increases, we are faced, as a society, with the need to study in depth both the future financing of the services and the need to derive the best benefits from them.
Because of the rapidly rising costs, the increasing demand, and the rapidly changing technologies associated with health care, Governments all over the world are being forced to find vastly increased sums each year simply to maintain health services at their current levels. We are not unique in this respect. The richest countries in the world are faced with this problem and on a larger scale. We must carefully look at the resources available for health care, so that we may continue development in the future.
I would repeat to the Minister that the greatest resources we have are the dedication and unselfish devotion of the voluntary organisations many members of which are helping out through sheer love of the work they are doing. I do not think the Minister has laid sufficient stress on the need to use voluntary effort to the maximum. In my own county we have friends of the mentally handicapped in St. Raphael's and Moore Abbey; we have the people involved in CARE who have done such excellent work for the education of the mentally handicapped; we have the people involved with the blind and many other people who give of their services and talents free. The Minister continually suggests in his brief that it is necessary that big brother should deal with all the problems. I believe the work should be delegated to local communities as much as possible, and in this way much good could be done even before the harm happened. Our health services should be made a recognised part of community life. If we spend money on our community services and help people to get timely and preventive treatment at home, every pound we so spend will be repaid tenfold and possibly save us £10 later if institutional care is needed.
I have seen in a very small way what a local health centre can do in a town. We have such a centre in Naas which was built principally by people who each year organise a party for senior citizens with whom I was closely connected. They organised a waste paper collection and got the resources to build a health centre. It has not been very long in existence, but we have a social worker who arranges visits, and older people and people from outlying areas come there. There is a chiropodist and even a hair stylist for the ladies. People who had led the life of a recluse have a new lease of life.
It is essential that old and infirm people, people who are handicapped, in wheelchairs, or blind people, be given an opportunity to mix with one another, to move about in society. A health centre such as this has given them that opportunity. People in my own area have had their lives transformed and look forward to their visits each week to the health centre for the sake of the company they meet and the crafts they learn there. Something more should be done to help the community services and to integrate these services into our health scheme. More money should be channelled in that direction where it will be repaid a hundredfold.
I wish to pay tribute to the Voluntary Health Insurance Board, a tribute that is all the more genuine when it is realised that it was the party that the Parliamentary Secretary represents that first introduced this board. It was unfortunate that the Government in which the Parliamentary Secretary is involved did a great deal of harm to the VHI board during the year. Voluntary health insurance is a great idea and a great help. I am involved in it myself and I have experience of the benefits of it. It relieves insured people of any worry about the future. At a time like the present when money value is deteriorating and living standards are being eroded daily, nobody is very anxious to provide for the future. But in this case people were very keen on taking out insurance so that they would be free from the worry and expense concerning problems that arise in every family. The VHI Board provided a wonderful opportunity of doing this at a reasonable cost but when the Minister spoke of his free for all scheme during the year there was great upset and people were considering cancelling their insurance proposals. People who had been happily insured knowing they were reasonably well covered began to doubt whether the insurance was a good thing.
The Minister's proposals never reached fruition and people's plans were again upset and they had to readjust to the situation. When the Minister discards his free for all idea —as I hope he will—I hope he realises that the voluntary health insurance is the very best scheme for all who want it.
Drink is generally considered to be one of the greatest social evils of the day. Whatever is in the Irish mentality it seems that we cannot approach drink—and possibly gambling and other matters—with any moderation; it seems to be the whole hog or nothing. In order to change our attitude to drink an educational programme is needed. In the present situation, apparently, all our social life centres around a lounge bar mentality and whatever we do is done either before we have a drink or after having a drink. There has been an increase in teenage and under-age drinking. This is an abuse which the Department must consider. I believe the education of children, provision of lectures and control of advertising are factors that must be examined. There is advertising of a very insidious nature that would tend to give people wrong ideas about drink and it is up to us to change that.
Closely allied to our drinking habits is the fact that we had 531 deaths on the road last year: there is a connection. This tremendous problem, after showing little change over a number of years, is generally seen to be increasing now and it must be examined. The Department are not giving any great lead in the matter.
The Minister's greatest mistake is that he has adopted this socialistic ideology. It is time for him to admit that the free for all which he envisaged is not on. He should get down to the ordinary work required to ensure that the very best results are obtained from the resources at our disposal. He should use and help the voluntary organisations to a greater extent. He should listen to the contributions from this side of the House which even, if he does not agree with them, he will find on examination indicate things that are wrong and the obvious shortcomings of the present system, the delay in dealing with dental and ophthalmic trouble and delay in getting appointments with consultants. The Minister must cut down this delay.
He should also look at the structure and working of the health boards. I realise now that the setting up of these health boards was a good thing although many on the opposite side of the House criticised them. It was only when we got the health board in Naas that we got improved facilities including two lifts in the county hospital—something our resources did not permit previously. Generally, our health boards have done and will continue to do good work. When the Minister talks of the huge expenditure that goes up each year he might well examine the structure and working of these boards. While I am confident that the work is good, I am also confident that it could be improved.
Again, I wish to thank the Minister for his courtesy on every occasion when I visited him during the year. He is very approachable. But in a year when he has been rowing with the doctors and other members of the medical profession there is grave need for him to review his own regime and give an account of his stewardship because, judging by the present political climate, it could well be that in the near future he might be steward no longer.