Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Tuesday, 27 May 1975

Vol. 281 No. 5

Vote 49: Health (Resumed).

Debate resumed on the following motion:
That a sum not exceeding £177,022,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 1975, 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)

A number of years back our late President, Erskine Childers, in his role as Minister for Health, was involved in a radical restructuring of the health services. It is appropriate, with the experience we have gained since that time, to see now if the community at large are securing the greatest benefit from the massive expenditure of 1/6th of the Exchequer expenditure on health services. It is obvious that a radical change of emphasis and a reallocation of financial resources are called for. Medicine should be brought into the community and an increased proportion of resources should be spent on community services and preventive medicine with a corresponding reduction in the hospital admissions and institutional care.

I believe health services should revolve around community care. It is the reverse situation at the moment.

The Minister referred to the need for community care services. He stated that it was not in his power at this stage to make the necessary radical changes. The present Administration, which is divided between two parties, will be incapable of making the very necessary decisions which will result in the re-direction of our health services.

The radical restructuring by the late President, when he was Minister for Health, brought about alterations in the health services and the health authorities. I believe we will have to wait for a Fianna Fáil administration to take advantage of the experience gained in the last few years in the operation of the health services and radically change the direction of the present financial expenditure in order to bring the greatest return, for the money expended, to the people.

It is necessary, when speaking on this Estimate, to talk about what we have and where we are going under the present Administration. In 1975 we have seen massive cut-backs in real terms because of inflation. A hospital in Dublin recently was denied a grant of £5,000 for a very necessary X-ray unit. They were told the patients could be taken to other hospitals for X-rays and brought back for operations. Surely something as elementary to the practice of medicine as an X-ray unit should not be denied any hospital, no matter how severe the financial restraints on the Department are?

The general operation of the health services in my area is under the Eastern Health Board. I would like to compliment the staff of that board for the way they administer their responsibilities, which are done in a very charitable manner. They treat each applicant for services as a human being and not as a number. Much of this excellent work will grind to a halt if the Minister is not prepared to provide them with the necessary money to expand. The money they have received this year will only allow them to stand still. You can only stand still for a short time as the service then starts to slip and it becomes less efficient. I appeal to the Minister to come to the assistance of the Eastern Health Board.

We expected north County Dublin to be serviced by the long promised Beaumont hospital. This was announced at at least half a dozen Press Conferences. I expected to be invited to its opening long before this but unfortunately there is not even a sod turned. This is at a time when there is a massive expansion of population in north County Dublin and the north city fringe area. There is a young married population in that area and the existing towns are expanding rapidly. Apparently the money is not provided by the Minister for a badly needed maternity hospital.

It should be one of the aims of any administration to have local health centres as the focal point of any community. Last February I asked the Minister for Health if he was aware of the need for a clinic to deal with minor emergencies in the Donaghmede/ Grangemore area of County Dublin and the steps he proposed to take for the provision of such services. He stated in reply:

I am informed that a minor casualty service for cuts and bruises is provided at the board's health services at Edenmore and Kilbarrack.

These are further cut-backs. In an area where there are nearly 2,500 houses, people are looking for a minor emergency clinic and because of the Department's approach and the Minister's lack of decision such a basic facility is not available. The population is comprised of a large number of children and when minor emergencies arise, such as cuts and bruises and so on, they have nowhere to go.

The whole situation in the north County Dublin area must be looked at with a view to a massive expansion of the health services. The only word to describe the expansion in the population in that area is massive and the health services have not been keeping pace. I appeal to the Minister even at this late stage to provide extra money for the Eastern Health Board to allow them to expand as we know they want to expand.

We also have a major psychiatric problem. Is proper use being made of our well-trained and concerned staff who are operating in St. Ita's Hospital in Portrane? Are we to have a continuation of the institutionalised type of treatment or should we not approach the goal of basing our staff at St. Ita's Hospital and moving out amongst the people and treating psychiatric patients in their home environment rather than bringing them to a psychiatric hospital? This type of radical decision cannot be made by the present regime and we must await the election of a Fianna Fáil administration to sort out the problem of such a radical change.

In the meantime, what about the conditions in which the excellent staff in St. Ita's Hospital are attempting to operate? Last February I asked the Minister if he would instruct the Eastern Health Board to replace the present temporary buildings used for housing patients in St. Ita's Hospital at Portrane by permanent structures. The Minister went some of the way with me with regard to the provision of a new 72-bed unit. We needed something much larger. The Minister said that proposals for rehousing the remaining patients were being examined. Being examined for how long? Under what conditions are the nurses supposed to work? Under what conditions are the patients supposed to be housed and treated while these proposals are being examined? I appeal to the Minister to speed up a decision on these proposals.

In north County Dublin, as in every other area, there is the problem of emergency accident facilities. In February I asked the Minister if he would arrange for the provision of emergency accident facilities for north County Dublin to be based at St. Ita's Hospital. The idea behind that question was that the nearest emergency facilities at the moment are based in Kilbarrack in the middle of a built-up area or at the fire stations in the city. If there is an accident along the North Road you have to call for an ambulance to come out from the city. Major traffic congestion is not unknown on that road. Because industries and the airport are sited there there are large traffic jams on the North Road.

Rather than having an ambulance coming out from the city to somewhere on the Balrothery Straight and turning around to go back into Dublin, my idea was that we should have an emergency unit based at St. Ita's Hospital so that an ambulance could go to an accident without becoming involved in a traffic jam. If necessary the unfortunate injured person could be taken to Dublin or Drogheda or to the emergency unit at St. Ita's. The hospital facilities are there. If they discovered at the emergency unit that they could not cope properly with the accident, the person could be taken by helicopter to a hospital in Dublin. This would save time and, as we all know, time is of the essence in the case of accidents and the treatment of people injured in accidents. We should have this type of facility based at St. Ita's.

All those who have spoken have given their own experience of the problems in their own constituencies with regard to medical cards and their allocation. I should like to add my voice to the chorus of calls for change in the operation of the medical card service. Each application for a medical card should be examined on its merits and not on rigid income grounds. I had a case recently of a child who was suffering from a rare disease.

The father and mother were doing everything in their power to look after the needs of the child and they were succeeding. It was imposing a monumental burden on the household budget to look after the child as well as they would like to. I made representations for a medical card, on their behalf, for the child. They realised they were not entitled to a medical card but we looked for a medical card for treatment for the child. It was refused because of the income of the father. This was a normal middle income family, living in a nice home and doing the best they could for the rest of the family and struggling, as most couples are, in that situation. If a medical card could have been provided for this child with a rare disease, the situation in that household would have been improved and the problem of the child could have been put into its proper dimension. Because of the rigidity of the regulations with regard to the allocation of medical cards, it was not possible to achieve that very desirable goal.

I should like to raise a few general points about the operation of the medical services. One is the question of the long delay being experienced by applicants for eye tests. I dealt with a case recently of a young first year university student. She came from a working class background, a description I despise. Her parents had made tremendous efforts to send her to university. That young girl was attending lectures but because of defective eyesight she found she could not read the blackboard properly and consequently was missing a lot at lectures. She asked for an eye test and was told she would have to wait three months. Therefore, three solid months of her year's course at the university would have been wasted. She came along to me. I took up her case with the health authority and they sorted it out for me. But there are many other people in the same situation who would not go to their local Deputy no matter from what side of the House he might be, and should not have to approach their local Deputy about such problems. A three months' delay for something as basic as an eye test is wrong and the Minister should endeavour to take some action in that respect.

The best principle to be applied with regard to medicine is that prevention is better than cure and in relation to the problem of alcoholism and smoking that principle should be emphasised particularly. I would appeal to the Minister to introduce and enforce a firm set of advertising codes, particularly on RTE. I am not saving that the other forms of advertising are blameless but I am concerned particularly about the drink advertisements and the messages being put across in them on television. Probably alcohol is the single greatest curse in this country. Even to view it on pure economics, in terms of a national loss, the figures are dramatic. In terms of human loss and misery experienced by families of alcoholics no money value can be placed on it. What do we see at present?

Despite general recognition of the problem of alcoholism, advertisements are put out on television which imply that success in business or attraction to the opposite sex is related directly to the type or amount of particular drink consumed. This is something we should abhor and about which the Minister should take some action ensuring that a proper code of advertising conduct is enforced by RTE. I know they do have a code of conduct. I know they have regulations. I have seen a copy of them. In themselves they are quite good but I do not think they go far enough. It is the flaunting of these regulations by advertisers which creates the problem. The Minister should have firm legislation available to him which he can implement in order to prevent the problem of alcoholism becoming even greater. The same can be said also in respect of smoking advertisements in the newspapers.

One aspect of the health service and the operations of the Department of Health to which not sufficient attention is paid is that of the health inspectors and their role. Again, we come back to the principle of prevention being better than cure. The health inspector should be the man preventing large-scale problems of abuse of facilities. I would appeal to the Minister to ask the health inspectors to pay greater attention to the toilet facilities generally in pubs, hotels and public buildings, especially in premises involved in the sale of food or drink. In many modern lounges there are to be found the plush carpets, soft lights and music in the sales area while, at the same time, the toilet accommodation is like something straight out of Dickens' time. There is nothing more disgusting for anybody, native or tourist, than to have to use such facilities. If the public toilet facilities being provided are that bad, what are we to assume are the facilities provided for the staff? And it will be the same staff who will handle food and drink and serve them to the general public. Surely that constitutes a major health hazard and comes back to the question of prevention. I would appeal to the Minister to ask his health inspectors to place greater emphasis on the question of proper hygiene in these pubs, hotels and other public buildings. A lot of that can be done by imposing proper regulations when granting applications for alterations or extensions to such public premises.

In conclusion, I should like to pay public compliment to the doctors, nurses and others involved in the health field for their dedication and attention to the people living in my area of North County Dublin.

The field of health is very vast, indeed, in that it touches directly every member of the community. I should like to confine my few comments to the area which I represent and then, if I may, enlarge the situation in the national context.

The constituency of Wicklow is difficult to administer from the health point of view. That difficulty is borne out by the problems experienced by people depending on where they reside within the county. Residents in the north of the county are well served by the hospitals in the south County Dublin area generally. They do not have great mileage to cover and, as Saint Columcille's hospital in Loughlinstown—to which I shall revert in a moment—develops it will cater for the growing areas of north Wicklow and its population. With regard to the west of the county, Baltinglass has a unit which was developed over the past few years. It meets the immediate needs of the community there. Not too far from Baltinglass there is a hospital in Athy and one in Carlow. Blessington is served by the Dublin area and Naas.

The people who reside in the Arklow area face special problems. Arklow is a growing town. Up to a short time ago it was a boom town but now it has been caught in the recession. Nevertheless, approximately 3.000 people are employed in industries there. The difficulties in that town arise because of its geographical location. Arklow is within the ambit of the Eastern Health Board and the nearest district hospital is in Gorey, ten miles away, which comes within the ambit of the South-Eastern Health Board. The people of Arklow have grievances and, more seriously, they have worries. They are concerned because maternity cases must be brought 45 miles to Dublin, or a little less to St. Columcille's. I know the Minister is aware of this. When he announces his plan for hospitals throughout the country I hope he will take cognisance of the fact that this is a developing area and facilities will have to be provided in the immediate neighbourhood. If the Minister should decide to develop the district hospital in Gorey this might meet the people's needs. Because of the risk for industries in Arklow facilities will have to be provided for the people of the area.

Planning permission for a health centre in Arklow has been obtained from the Wicklow County Council. This will meet many of the day to day needs of the community. It will provide services for the young and the aged but will not offer the maternity facilities required. If there should be a small disaster in the area—we had one blast in the fertiliser factory which happily did not result in any loss of life or suffering—what would the Minister and his Department do? This is a very difficult situation. The Minister has met deputations. We have met representatives at the local advisory committee level in Wicklow and have passed the representations to the health board. The health board officials have met with the officials of the Department on two occasions. I am sure the Minister is aware of this. If he is so aware, I hope he will activate his awareness by coming up with a definite proposal for the area.

There is very heavy traffic on the roads between Dublin and Rosslare. Even though these roads are being continually improved, the traffic tends to slow down the transportation of patients. Therefore I hope the Department will give the area what it needs—a good district hospital. Of course, I realise that the costs would be very heavy. I would appreciate it if the Minister in his reply could give some hope to those people so that they can see that some progress, even if it is only theoretical, is being made. As I said, it is practical progress we desire but that appears to be a little further off now due to the cut-back situation.

Blessington and Dunlavin have been assigned a health centre. Limited capital to commence operations has been made available by the health board. This indicates exactly the cash difficulties at the moment. It would appear that the clinic programme has been held up because of shortage of money.

St. Columcille's Hospital is to be developed. It needs developing on a few fronts. Might I remind the Minister of the urgency of having heating, hot water, electrical and mechanical services provided for this hospital? The consulting engineer of the health board is very worried and concerned about the condition of existing services which are overdue for replacement. I hope that action will be taken on this front.

I have a note in front of me which states that on 29th January, 1974, a report was given to the local visiting committee. The members expressed concern and said that their officials were in touch with the Department of Health. They were asking the Department to make a capital allocation available for the work which will cost in the region of £100,000. I read the Minister's speech and the documentation furnished with it but was unable to trace the £100,000 for this work in Loughlinstown hospital. I believe there is a plan with the Department for the provision of 200 beds for an adult mentally-handicapped centre in that hospital.

I should be pleased to learn of the progress that has been made. I saw a copy of the plan which seemed to have been very carefully drawn up, meeting all the needs. I was present at the visiting committee meeting and I thought afterwards that this scheme for Loughlinstown would get the green light in the Department. I wonder if there is some difficulty besides finance holding up the scheme. The site is available and development could commence if the cash were there. Perhaps the Minister will advert to it in his reply. I know he is concerned personally with the problem of the mentally handicapped as well as being head of the Department of Health. The Loughlinstown development would go some way towards relieving the strain in other centres such as St. Ita's.

I have been looking at the allocation my health board received from the Department for this year, £23.5 million. It was notified to us on 20th November last and the document which accompanied it stated it would maintain services at their present level. Many Deputies have referred to the point that it is not possible to maintain services at their present level even with increased allocations. The Minister has a statement from my health board, dated 9th April last, seeking supplementary funds of £1.315 million. This includes a number of items of excess expenditure, all of them essential. I do not know if it is the Department's policy to make a certain sum available on the hypothesis that if pressure is put on them they will come up with more money. If that is so it is bad policy because it does not facilitate planning ahead.

Reference has been made to dental care and treatment. I have details of the allocation by the Department towards dental appliances and external dental treatment. I also have the estimated expenditure for 1975, based on trends, from the staff of my health board. The departmental allocation towards dental appliances as listed in circular HSG 330, dated 20th November, 1974, is £22,000 whereas the estimated expenditure by the board was £32,000, a shortfall of £10,000. For external dental treatment, the shortfall between the Department's allocation and our estimate is £24,000— £6,500 allocation as against estimated expenditure of £30,500. Of the Department's allocation of £6,500 a large proportion would go in grants to the dental hospital. We are concerned about dental care and if the Minister wants to try to catch up with the backlog——

I agree the backlog has been there for a long time.

I agree it is difficult to catch up with a backlog but if it were a receding backlog it would not be so bad. The Minister must take a good look at this. Perhaps he would come up with the extra money needed to remove this backlog, which is a growing one. Not only have we lists of people seeking dental care at our various health centres but added to them are adults from the eligible non-insured section. Has any agreement been reached with private dentists to try to erode this backlog? I understand discussions may be under way between the IDA and the Department on a fee per item basis. Is there any indication that agreement is near? It is only by incorporating more dentists from the private sector that we will have any hope of coping with the demand for treatment.

Debate adjourned.