The introduction of this Supplementary Estimate by the Minister for Health at this stage represents a classic case of bad administration. It is a clear example of how not to conduct government business, of how not to administer a public service such as the health service. The Minister, in pursuance of the usual practice, in the early part of the year introduced an Estimate for his Department. Many of us pointed out to him, as clearly and as strongly as we could, that the allocations we were making were inadequate and would not enable the institutions concerned to get through the year and provide the level of services available in previous years.
It was obvious to everybody at that stage that the provisions being made by the Minister were inadequate and the fact that he is now bringing in this Supplementary Estimate for approximately £12 million proves we were absolutely right in what we said to him at that time. However, let us look at what has happened to the health services during the course of the year.
There have been dislocations and cutbacks, some services have been terminated and others run down, all because of this unreal economy by the Minister who endeavoured to push it through, presumably at the request of the Minister for Finance. It was obvious that the economies the Minister was attempting to impose on the various institutions would not succeed and they have not succeeded. The Minister has now to come along and provide the money he should have in the original Estimate. In the meantime, the time and energy of the health board executives and the hospital managements have been taken up with trying to do the impossible, trying to meet the stringent economies laid down by the Minister and at the same time carry on some level of service.
On the 30th March last we were discussing the Health Contributions (Amendment) Bill, 1976 and as we came to the end of the Second Stage discussion I asked the Minister very specific questions. I want to quote from the Official Report, Volume 289, No. 4, column 522 of the 30th March, 1976:
Mr. Haughey: Before we take a decision on Second Stage I want to know from the Minister are the allocations made to the different Health Boards final and can they be increased under any circumstances.
Mr. Corish: They are final.
Mr. Haughey: Will they not be increased under any circumstances?
Mr. Corish: They are final.
On the 30th March, 1976 the Minister for Health indicated to the House clearly and categorically that those allocations would not be increased under any circumstances, that they were final and conclusive. The unfortunate executives of health boards, the management of the hospitals and all the people throughout the health services at the different levels took that statement by the Minister at its face value. They took his word and they proceeded to cause disruption and chaos throughout the administration of the health services.
I want to go a little further and point out that at that time of the year also during the course of the same debate on the Health Contributions (Amendment) Bill on the 24th March, Volume 289, No. 2, columns 270 and 271 of the Official Report I said:
It is very difficult for anyone outside the official establishment to quantify what additional amount is required to finance our health services this year. From my own limited knowledge and using whatever information I can assemble, I believe that the regional health boards between them would require an extra £8 million this year if they are to maintain their services at a satisfactory and adequate level.
Mr. Corish: Each health board.
Mr. Haughey: No, between them. That is the calculation I made to the best of my ability. I have taken them all together and put particular emphasis on the Eastern Health Board and have looked at the others and the difference between their budgets and what has been allocated to them. I believe that the eight regional health boards between them would require an extra £8 million this year to provide adequate health services at the same level as existed during 1975.
I believe that another £7 million to £8 million would be required for the voluntary hospitals and the general medical services payments board. This means that in the region of £15 million would be required in the Estimate for the Department of Health to enable our health services to get through this year without serious disruption....
I went on to say that it was difficult for somebody in my position to try to calculate exactly what the short-fall was but I gave that £15 million as my best estimate. I further said:
I suggest that the Minister should try to get it across to the Government, where the ultimate decision in these matters lies, that that additional money must be provided by the Exchequer. I also want to make it clear that it is not my responsibility to propose how those funds should be provided as I have not the details of budgetary policy and the different demands and pressures which would enable me to decide where that £15 million is to come from. That is the responsibility of the Government.
I want to submit that what I said at that time was as near to being accurate as it could possibly be. We now have the Minister coming before us looking for an extra £12 million approximately. I said in March that he should have added an extra £15 million. I submit that the case I made at that time has been fully borne out by events. If the Minister were to put the matter on a proper footing at this stage, he would probably make this Supplementary Estimate £15 million as I stipulated at that time.
The Minister, in any event, is now looking for an extra £12 million. Why did he put the general public, the health boards and all the people concerned to all this agony? Why did he subject them to all this disruption throughout 1976 when everybody knew that sooner or later he would have to come along and make this money available. It is a classic example of bad administration and a short-sighted approach to this crucially important aspect of Government administration.
There is a further thing about this that we must take account of. Will anybody ever again take the Minister for Health seriously when he comes along with a particular Estimate, puts it before the House, the institutions and the agencies and says: "That is the allocation for this year"? He has done a very serious, far-reaching dis-service to the administration of the health services by the way he has carried on this year. He came before the House and said: "This is the allocation. It is final. Under no circumstances will anybody get any more money." It could not have been more categoric. Under tremendous pressure from this side and his own side of the House and from all round the country he stood fast and said: "Under no circumstances will there be an extra penny granted. You have got to live within these allocations." We now find that was all bluff, that it was some sort of exercise he was going through. He is now making the money available in spite of those categoric statements he made.
I am not interested in exposing that particular piece of deceit by the Minister but I am concerned about the lasting impression this conduct will have on the situation in future years. When the Minister for Health comes to the Department and the Dáil and puts forward an Estimate and says: "That is final, that is it for the year" nobody will believe him. The health boards will say that it is only an exercise and he has to go through this formality because the Minister for Finance is slashing all the Estimates. They will tell people not to worry, to carry on as they are, to spend whatever they feel like spending, that the Minister will bring in a Supplementary Estimate at the end of the year and that everything will be all right. That is a very unsatisfactory and unhappy situation to which the Minister is now committing us. I suggest that by his behaviour in this regard this year he has seriously undermined the credibility and the future of the departmental Estimates process. The different bodies, the different institutions, the different individuals concerned in future will not take seriously the Estimates as put forward by the Minister for Health.
The Minister did not comment in detail—in fact he hardly commented at all—on what happened to the health services during 1976. We all know what happened. We know 1976 was a bad year for our health services. It was a year of confusion, a year of dislocation, a year of deterioration. I do not think any sensible objective commentator could suggest there has not been a deterioration in the health services in every area during 1976. A number of very important and very valuable services which were being brought along and built up over the past four, five or six years were suddenly set back, terminated or reduced in scope.
It is not enough to say there was no development during 1976. There certainly was no development, no improvement, no expansion in our health services. More than that, because of the Minister's approach to the financing of the health service there has been a serious deterioration in many areas. I would have thought the Minister, in introducing this Supplementary Estimate, would have commented in some way on how things developed during the course of the year. Every Deputy knows the damage done in particular areas. I suppose the hardest hit area was the area of community services. The very valuable progress which was being made in the building up of these services received a very traumatic set back.
Anybody engaged in social work knows the extent of the damage done. Meals on wheels, home help and a whole variety of these essential basic community services were seriously interfered with, cut down and emaciated. Quite a considerable amount of hardship was caused throughout the community as a result. On a number of occasions we have discussed in this House the question of the school inspection scheme. There again very serious disruption has been caused and very serious cutbacks inflicted by the Minister's Department.
It would be impossible to over-emphasise the importance of that scheme. Admittedly some of our medical men in the House argue cogently that they would prefer to see all the inspection and examination which need to be done, done before the child goes to school. I suppose in an ideal society that is the way we would like things to be, that we should not have to wait until our children are at school before having this inspection carried out and having whatever defects or ailments exist identified. Whatever about that counsel of perfection, it is certainly essential at this stage that the school inspection scheme should be fully, completely and comprehensively administered every year.
Apart from the health of the community and the happiness and welfare of the individuals concerned, it is good economics to detect ailments and defects at that stage so that the necessary corrective treatment can be applied. Ultimately this must redound to the health of the community and to reducing the cost of the health services to that extent in the future. That is one area in particular which has been seriously affected by the approach of the Minister to the financing of the health services this year. Everybody connected with the services knows there has been a deterioration in the administration of that scheme. I suppose at this stage all one can do is urge that in the Estimate for the coming year the matter will be put right. As I say, it is not just good welfare policy but also good sound national economics.
The dental service is another area related to schools where the situation is appalling. Every Deputy knows how bad things are and how long the waiting lists are. It is an inadequate skeleton service at this point. Whatever attempts were being made to improve matters down through the years were suddenly rudely set back this year and the situation is now worse than it ever was. The same applies to ophthalmology. I understand the waiting period for glasses for those who need them has lengthened very considerably, up to three months now and over three months in some cases.
Another very false economy was the cutting out by many of the health boards of the transport service provided for patients who have to get to hospitals or clinics. Again, every Deputy has first-hand knowledge of the hardship this caused throughout the community. As we always do at these times, we heard a lot of scare-mongering stories about waste and inefficiency in the administration of this transport service. There will always be some element of waste and inefficiency in the administration of any public service. The brutal approach by the health boards, at the instigation of the Minister, to this transport service caused untold unnecessary hardship in those areas of our community where it should not be caused, and where we should go to any length to avoid causing hardship.
Sometimes it is difficult not to become cynical about this sort of thing. One has the Parliamentary Secretary to the Minister for Social Welfare, Deputy Cluskey, coming in here lecturing us, talking of schemes to combat poverty, going through a whole rigmarole of pilot schemes to root out poverty and combat it. Does this not all become a bit sickening when, on the other hand, we see the same person doing these sort of things to basic, humanitarian community services? A mentally handicapped child living in a Dublin suburb or in a remote rural area is being deprived of transport to the clinic or hospital to receive the attention he needs. What is the point in talking hypocritically about combating poverty when we have this sort of thing? Before we start on any textbook, pipedream type of activities, let us deal with the simple services we have available to the community. Let us make the necessary finance available to ensure that they operate with a reasonable degree of efficiency and comprehensiveness.
It is very difficult to understand why the Minister for Health permitted himself to be walked into this type of situation this year. I do not know who is at fault. It is not fair to blame the Minister for Finance for everything; he has his job to do and is subject to various budgetary pressures. Naturally he endeavours to keep all the departmental Estimates as low as possible. But the Minister for Health should not have accepted this situation. As we asked, he should have indicated to the Minister for Finance that this would not work, that this extra money was needed. In my amateurish, outside way, with no access to any figures, I see that what was estimated at £15 million has turned out to be £12 million. He should have told the Minister for Finance he would have to get the money at some point during the year. He did not and he must be held culpable for that.
I should like to avail of this discussion to mention one or two matters of pressing importance in the present administration of the health services. Admittedly these are difficult times from the point of view of financing all of our public services. Because of the serious mismanage-of our finances over the past four years the Government now find themselves in a position in which it is difficult to obtain the necessary resources for the most essential services amongst which, of course, health would rank as a top priority. Nonetheless I want to draw the attention of the Minister to some matters which should be under consideration at present. Not all of them involve additional finance. One I want to mention does—it is the question of the EMI scanner. This matter was raised here on a number of occasions.
I want to ask the Minister, or his Parliamentary Secretary, to give very serious consideration to the situation which has arisen in regard to the provision of a scanner. Everybody engaged in medicine and the administration of the health services is convinced that we must have at least one, and possibly two, of these magnificent new machines and that they would result ultimately in very considerable savings. I do not think a decision in ths regard can be postponed much longer.