We in Fianna Fáil have decided to support the establishment of this new all-party Select Committee on health and we intend to participate fully in its work and to try to ensure that it will make a worth-while contribution to the development of a sound, satisfactory structure of health services. We intend to nominate to represent us on this committee a carefully selected team of Deputies all of whom have a very special interest in and knowledge of our health services and who, together, will be widely representative of the various health board areas.
I wish to express my appreciation of the Minister's approach in discussing with me and agreeing the terms of reference of the committee and also for his agreeing to discuss the situation in regard to a chairman of the committee. As the Minister said there must be grave doubt in regard to the value of establishing this committee at this time—the closing stages of this Dáil. It is extremely doubtful if the committee can achieve anything worth while before being dissolved with the Dáil. Nevertheless, as a responsible Opposition it is our duty to support the committee. In so far as the Minister has outlined what the committee might hope to achieve, we agree with him. As an Opposition it is our duty to oppose policies and actions of the Government which seem to us to be unsuitable or detrimental and to point out mistakes. It is for us to indicate where we see neglect, inefficiency, injustice and malpractice on the part of the Government. On the other hand, throughout the life of this Dáil we have supported and encouraged any policy that seemed worth while or beneficial. We have put forward alternatives suggesting improvements or better lines of approach to various problems and issues. Sometimes, perhaps, in the hurly-burly of parliamentary debate and processing we may be inclined to forget the underlying fact that the health of our people is of fundamental importance to the community and that the provision of the best health service possible that we as a community can afford is a basic obligation on both Government and Parliament. In discharging that obligation we regard it as our duty to contribute as fully as our experience, our knowledge and our abilities permit, to the work of this committee.
There are many areas in the administration of the health services and in the construction of policies in which there is room for disagreement, valid disagreement. We reserve our right to disagree with the Government on any area of policy or administration where we deem it necessary to disagree or where we think we should criticise, oppose or propose. I wish it to be understood and acknowledged that the establishment and the existence of this committee will not prevent normal Dáil treatment and processing of health questions and issues. The committee must function side by side with the normal parliamentary process and not be in substitution for it. We will not tolerate—I do not think the Minister would expect this of us—any sort of sub judice situation where discussion or debate would be sidetracked on the basis that something was being examined by the committee. It is not our intention to allow the committee to become a blind alley into which controversial issues are diverted. On the other hand we believe that if used properly the committee can be effective in establishing a great deal of common ground and can be used to ascertain facts, to define problems, to identify deficiencies, to isolate prejudice, privilege and self-interest in existing structures and to set out certain priorities on which, perhaps, we could all agree.
The time is opportune to look at our health services in an over-all economic context. An attempt must be made to settle the place health will occupy in the national scale of expenditure, to decide what proportion of annual State expenditure should be devoted to Health. This year 14 per cent of the current budget will be allocated to the health services. Health is the largest single item in the current budget, slightly greater than the total amount being devoted to education, for instance. Looked at from another point of view, in 1977 we as a community will devote to the health services the equivalent of 6 per cent of our GNP. We must ask whether these are the right sort of relativities. Should the over-all expenditure on health services be contained at this level? If a stated percentage of the GNP were decided on the total amount available annually would increase in line with the national prosperity as reflected in the GNP. Such a system would have many attractions. It would ensure a certain degree of stability and consistency in the State's contribution to the financing of the health services. A consistent approach in this vitally important area of national economics is absolutely essential.
I suggest that the incredible mishandling of the situation in regard to the financing of the health services in 1976 must not be repeated. During 1976 serious and widespread destruction occurred in this area and hardship was caused as a result of the inept way in which the Minister and his Department approached the health expenditure for the year. Estimates were published at the beginning of the year which were stated categorically to be final, conclusive and unchangeable and on the basis of those estimates various institutions, agencies and organisations reached certain difficult decisions but towards the end of the year additional amounts were provided by way of supplementary estimate which meant that the hardship, the disruption and the dislocation need not have occurred at all. That sort of stop-go situation, if at all possible, must be avoided in future. It results from bad budgeting and bad planning. The ideal approach would be to have a gradually expanding budgetary provision which would be adequate to cater for the existing level of services in any year and at the same time to allow for some element of planned, phased expansion and improvement.
Some total over-all State contribution could be decided on on an annual basis. There would arise the question of how services which could not be catered for within that budget could be made available. This brings in the question of voluntary effort or of some voluntary or compulsory insurance system or some system by way of private payment. There is a variety of systems in many different countries, all of which will have to be studied and examined carefully by the committee. There is an almost infinite permutation and combination of systems which will present themselves to the committee for examination.
A committee will have to examine, too, in a very searching way the cost benefit aspect of our health services. We must ask whether we are getting the greatest benefit possible for the greatest number of people possible from the expenditure involved. It is regrettably true that in recent years very considerably increased expenditure has not brought better value and better services for the people with regard to health. In many areas the cost of services has escalated but the quality of the services and their availability has disimproved, so that we cannot have any sort of comforting feeling that it is simply a matter of providing more money. The lesson in recent years is that escalating costs and increased expenditures do not necessarily guarantee better services for more people. I am not saying this in a party political sense. There are far too many bottlenecks, delays and waiting lists in the existing structure of services. In many cases at present services are theoretically available but in practice the waiting lists are so long that they are not available to the people to whom they are supposed to be available.
I hope that at an early stage this committee will examine the structure of the general medical service. We could all agree that there is a very urgent need for a much better administration of that service. We would also agree that that service is perhaps the basic element in our health services. It is the service to which the greatest proportion of our population have to have recourse. An efficient general medical service available to those who need it is essential for a proper structure of health services. There are abuses, maladministration, duplication and overprescribing. We all know that. I hope that this select committee will carry out a very detailed, searching and comprehensive examination of the general medical service. There is not much argument now between us as to the level of eligibility for medical cards. That will derive from an examination of overall costs.
The only difference there might be between us is in regard to the priority that should be afforded to the general medical service in the allocation of funds as against other divisions of the general health service. In the idiotic process which we have had to suffer there are instances of rising costs leading to an insupportable level of expenditures, followed by savage, indiscriminate cutbacks. That sort of process will have to be avoided somehow in the future, because that approach does irreparable damage to the whole structure. In that regard it is regrettable that the first thing that suffers in a cutback economy drive situation are the community services. That is bad economics as well as being undesirable from the humanitarian and compassionate viewpoint. I hope this committee will examine and devote a lot of attention to how to an increasing extent medicine and health can be brought out to the community, through community care programmes, so that we get away from this indiscriminate cutback situation where because of its nature the community care programmes lend themselves to the greatest retrenchment.
There are very many areas to which this select committee will devote their attention. It is important to have this committee. Ultimately they will be working in a sort of situation where needs are infinite and resources are limited. No country in the world could afford to provide for its people all the services that are technically and scientifically now available. It is a question of sorting out priorities and taking tough decisions. We have a structure at the moment which has its blemishes, its bottlenecks, its waiting lists, its inefficiencies and which has been from time to time subject to disruption and dislocation. On the other hand it is on the whole a structure which has steadily improved over the years. I hope the aim of this committee will be to ensure a planned, phased improvement. Since the Voluntary Health Board has been one of the great success stories of our recent health history, I hope the committee will look very seriously at expanding and developing the scope of the voluntary health organisation. They will also have to give a great deal of attention to other methods of financing health expenditure, of enabling services to be provided in some way other than by direct State subvention. If we go about it properly the establishment of this committee can be very beneficial.
While I certainly have to complain to the Minister that this committee was not established at the start of this Dáil, I agree with him that, even at this late stage, setting it up now can have some benefit. At least it can lay down some guidelines for the next Dáil. I suppose the best service this Dáil can render at this stage is that we can put our experiences down on paper for the benefit of the incoming Dáil. This is one area where we can do so. It is worth while establishing the committee and getting some experience, in the time left to us, of the scope of the work and at least looking at the lines and the approach the committee might follow.
Our agreement to participate fully in the work of this committee derives from our determination not to play party politics with health and not to let party political considerations influence our approach to the general welfare and to the people's health. It was open to us to refuse our co-operation to the Minister in this way, to let him flounder on his own, and to leave him caught up in many of the problems which his ideological approach to health has created for him. We have chosen not to do that. We are offering our full constructive co-operation in making this committee work for the benefit of the people. That is our primary duty as a responsible Opposition. We are fully prepared to co-operate with this committee and we welcome its establishment. We also welcome the approach of the Minister in offering us full consultation in regard to its establishment and its terms of reference. We hope that if we establish it in that way and in that atmosphere it will, even in the short time left of this Dáil, make a worth while contribution to the administration of our health services.
