Vol. 307 No. 12
: I move:
That a sum not exceeding £357,078,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 1978, 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.
: As the Minister and his Government have now been in office for almost one year, it is perhaps appropriate to examine the activities of the Department of Health during that period. Unfortunately, the rather unsatisfactory way in which we are asked to see through a myriad of Estimates in a very restricted period of time leaves me in the position that I would almost prefer not to have to speak in this restricted way. There are a few comments which are appropriate, in view of the parliamentary discussions which took place during the year and of the activities of the Department.
It would be fair to say that the occupant of the office of Minister of Health took up duty with a fanfare of publicity and has continued in that office with a constant veneer of publicity. However, there comes a day when the review bodies, the consultations, the investigations, the working parties and the considerations have to stop. There comes a time when the reviews have to be reviewed, the consultations finished, the investigations concluded, the working parties make a report and the considerations are considered. In the last 12 months I do not recall a single area where the Minister in a reply in this House has ever been able to say that any investigation, consultation or consideration had been concluded or that any working party had actually reported and that something had been done on foot of that report. After a year in office I think we should suggest that, instead of working parties, the Minister should set up a search party to go out and find some of these people who have been very magnanimously taking the burden of decision-making from the Minister and allowing him the full range of his considerable talent for garnering publicity.
It is fair for us to ask now what has this Minister, who came in so full of promise, actually delivered. At the end of Question Time today he ventured to suggest that in the course of this year we have seen the commencement of Beaumont Hospital, the commencement of Tralee Hospital, and the commencement of an extension for the Mater Hospital. He also suggested the commencement of Cavan Hospital, but Deputy Fitzpatrick dealt adequately enough with that to show it was not valid. I repeat that not a single project was initiated by this Minister or by this Government. The single item that stands to the credit of the Minister is that he advanced the plans for the commencement of the building of Beaumont hospital, a hospital that had been decided on by his predecessor. The site had been decided on and the plans were well advanced before the Minister took office.
: The site had not been bought.
: Indeed, the Minister by his action delayed the plans for Cavan hospital because he transferred to Beaumont the team of design consultants appointed to Cavan. This meant that another team of consultants had to be appointed for Cavan Hospital thereby retarding the hospital's progress.
I am in full agreement with the decision which has meant that the physical building of Beaumont is now under way but it is proper that one should express a certain amount of caution and that the Minister would heed that caution. It is said often in hospital-building circles that every hospital is obsolete on the day it opens, that this is due to the length of time taken from conception to completion because by the time of completion there are already far more modern, more advanced and more sophisticated ideas on the drawing boards of hospital architects throughout the world. In that context it is fair to express a degree of caution regarding the taking of plans for a hospital at Wilton which were conceived about 10 years ago and using them as the basis, almost as the entire blue print, for the building of a hospital at Beaumont, especially when one bears in mind that the architect for the hospital at Wilton was employed specifically, because at the time he had just completed work on a hospital in Scotland and it was considered that his designs for the hospital there, which was of a size similar to the one at Wilton, could help in advancing the building of Wilton hospital. The idea for that hospital in Scotland was conceived about 1950. If we trace back the plans for Beaumont we find that the idea for it as it is now being built physically emerged somewhere in Scotland almost 30 years ago. Although we are told that modern hospitals are obsolete on the day they are opened, here we have a hospital that is not simply a copy but a second-hand copy of another hospital. There should be an examination of the different design areas at Beaumont to ensure that in so far as possible the more modern ideas are incorporated during the building process. On another occasion I endeavoured to put forward that suggestion in the House but the Minister did not appear to be receptive to what I was saying.
There have been complaints and criticisms from some professional people engaged in the field of medicine regarding the lay-out and the provision of facilities at Wilton. When I suggested to the Minister that he should pay attention to that situation his reply was that it is not always he believes what he reads in the press. That is not good enough. If professional people—theatre sisters and others—engaged in the work of ministering to the sick point to a lack of facilities or to bad design in relation to their hospitals, it is hardly fair to say: "I do not believe it so I shall not do anything in that regard in respect of a replica hospital being built in Dublin."
While accepting that the Minister has seen begun under his aegis, but not by way of his initiation, those hospitals that he mentioned today during Question Time, is it not fair to ask him what has happened to those hospitals he mentioned so frequently a little more than a year ago? What about, for instance, Roscommon, Tullamore and Monaghan hospitals from which the Minister enjoyed considerable political mileage and acclamation, translated into votes, presumably, because of his promise that they would not be downgraded, that he would ensure that not only would they be continued at their then levels but that they would be upgraded? There has been a marked lack of verbosity from the Minister in relation to Tullamore hospital since he came to office.
: No problem there.
: That seems to be a phrase used commonly by the Minister and his colleagues. There has been a great lack of attention and a refusal to meet local interested parties concerning the hospital at Monaghan.
: No problem there.
: The silence on the part of the Minister and his Dáil colleagues at a meeting with members of Roscommon County Council yesterday has been noted. At that meeting the Dáil Members were asked to verify their public assertion that there would be an obstetrician-gynaecologist at Roscommon Hospital considering that the local health board knew nothing about this.
: There is a problem there.
: Progress. We are getting somewhere now.
: There is a very real problem there.
: Perhaps when replying the Minister will outline for us at what stage the proposed federation between Roscommon and Portiuncula hospitals will commence.
: It will be coming into operation on 1 July.
: If so, will an obstetrician-gynaecologist be provided at Roscommon to allow the maternity unit there to operate satisfactorily? If there is no problem in regard to Tullamore Hospital perhaps the Minister will confirm that it is intended to appoint an obstetrician-gynacologist both at Portlaoise and at Tullamore and also a paediatrician bearing in mind what the profession have said, that is, that two obstetricians must be appointed to each of these hospitals if the maternity units are to continue to be serviced after three years from now.
The people of those two areas should be delighted to hear that sufficient qualified staff are to be appointed. The local health board, too, should be very pleased with the news. The only ones who may not be pleased are Comhairle na nOspidéal who during the past couple of months have informed the health board that they would not allow those two units to continue and who invited the health board to make the unpalatable choice as to where the single maternity unit should be. That is not the business of the health board who had asked that the units be continued at each hospital.
: That will be the case.
: Rather than by way of interruption I invite the Minister to avail of the opportunity of replying to this debate——
: That would be wiser.
: ——to put clearly on the record that he will have sanctioned the provision of sufficient staff at these two hospitals. By that I mean one obstetrician-gynaecologist and a paediatrician, having regard to the necessity to appoint a second obstetrician-gynaecologist within three years to each of those units in order to ensure that they continue as complete maternity units.
I expect that the Minister will be glad that I offered to speak on this Estimate, thereby providing him with the opportunity of giving a clear and categorical assurance that he intends seeing Tullamore and Portlaoise hospitals upgraded. He may avail of the opportunity of replying to give a categorical assurance, too, that Monaghan hospital will be upgraded. I am not inviting the Minister to do anything he did not promise a year ago or even 18 months ago. He is being given the opportunity now to assure the House that he will deliver on the promises made before the election.
: The Deputy is playing politics with the health of the people.
: The first one to kick this political football is the Minister. It is about time the whistle was blown, the ball was collected and the sums were done.
: The Deputy has no interest in the people's health.
: Deputy Boland, on the Estimate. Time is limited.
: I agree but the time involved in regard to these hospitals extends back for more than two years when they were made political footballs of and tossed around like corks on the sea, not only by the Minister but by the Taoiseach and by their local parliamentary colleagues in the constituencies concerned. I have visited those areas and have spoken with the people who believed the promises would be fulfilled and I am inviting the Minister now to reassure them.
An undertaking in the Fianna Fáil manifesto was that in government Fianna Fáil would see the setting up of an all-party committee on health matters. I was out of the country last week on public business and shortly before I left, after the Minister being a year in office, I was contacted to know when would be a suitable date for holding the first meeting of that committee. A few months ago, when I tried to find out when the all-party committee were to meet, the Ceann Comhairle ruled my question out of order because this all-party committee was not a Committee of the House. I did not understand that this proposed all-party committee was not to have responsibility to the House, was not to deliver reports to the House and was not to be involved in the discussion of health matters on behalf of the House. One would have thought from the Minister's contribution to the Supplementary Estimate of the Department of Health on 8 December last that this all-party committee would have a great deal of importance. I ask the Minister to listen to his own words very carefully. He said at column 1065, Volume 302, of the Official Report:
The committee of the House will be set up very shortly and I look forward to them performing a very useful and important role in the administration of the health services.
We have since elucidated that the committee will not be a committee of the House. The committee was not set up very shortly after 8 December last. The first attempt to set this committee up was a fortnight ago. I suggested that it should meet this week but I have heard nothing since.
Early on in his occupation of the office of Minister for Health the Minister promised us a major review of the Mental Health Act and said that it was urgent that there should be a nucleus of legislation in this field. We have not seen it. In Private Members' Time during the last few months we have discussed various issues, including the dental services. Apart from the appointment of a dental adviser we have not heard a single commitment or decision on the Minister's part towards the improvement of the dental services which we made very clear were inadequate. During Question Time over the past year a number of Deputies have outlined the lack of services for the physically and mentally handicapped. Nothing has been done to improve the situation.
The item which has possibly drawn the most attention here is the income limit for eligibility for health services for non-manual workers, which still stands at £3,000 a year. The Minister in this field at least has made a definite decision. He is resolutely against extending that income limit and has used the excuse that he hopes to introduce next April a pay-related insurance scheme for health services. Quite apart from the inequity to those noneligible people being deprived of health services, which continue to be costly and for which the Minister recently sanctioned an increase of 20 per cent, he has not outlined the method by which he intends to introduce this pay-related insurance scheme. We have been given no indication of the burden which will fall on the employer and the employee and what share the State expects to take up as the remainder.
The social welfare insurance stamp now pays for over 80 per cent of all social welfare benefits paid as opposed to social assistance payments. The total amount brought in by the health stamp at the moment is approximately £16 million and the entire health services are over £380 million. When one bears in mind the areas of the health field of that £380 million that will not be covered by the insurance contributors there will obviously be a gigantic shortfall between the existing revenue from the health contribution stamp and the revenue the Government would like to see if a national pay-related health insurance stamp is introduced. This issue causes considerable worry to many people because the Government have given no indication of what burden they expect either the employer or the contributor to bear in the insurance stamp. It is now time for us to hear how it is intended that this scheme will be implemented and the percentage the ordinary individual will have to contribute.
: I must remind the Deputy that we have 40 other votes to get through. I cannot stop him even if I wished to do so. If I remind him that we have 40 votes to get through, many of which are very important——
: I am quite sure the Chair has no wish to stop me. I am about to finish my remarks. I believe, after reading the Green Paper issued a fortnight ago, that we have hard times ahead, particularly for everybody who will be asked to become involved in this health insurance field. It is better if the harsh realities are outlined to them now. When I spoke on the Supplementary Estimate last December—I would like to repeat it now—I referred to what was said when the eight health boards were set up following the advice of McKinsey in 1970. He recommended that after five years in operation the structure and achievement of those health boards should be reviewed. The health boards have now been eight years in operation and no review has been carried out. Even though I dislike review bodies and working parties, which remove the responsibility of decision-making, I believe that a review of the effectiveness of the health boards and the level of services they are providing should have been carried out, as was recommended by the initiators of the revised health boards scheme. I invite the Minister, even now, to consider introducing that. The situation with the Department of Health, as has so often been the case with that Department, is that they have sailed gaily along in their own relentless way while the helmsman was being photographed on the quayside.
: Before the Minister replies, I do not think the Taoiseach made it clear if a token amount would be introduced in the autumn. Could the Minister give any indication about that now?
: I am not aware of any such proposal.
: This is the usual thing when there is a short debate like this one today.
: I have no objection to it but I am not in a position to give any commitment.
: With regard to Estimates the Minister makes an opening speech and outlines policy.
: That is the normal procedure.
: I hope we will be able to have a full debate on a token Estimate.
: Listening to Deputy Boland, it is difficult to think that he and I are living in the same world.
: The Minister is living in my constituency.
: On the general question of hospital building, on the one hand Deputy Boland castigates me for setting up working parties and says it is an excuse for not making decisions. On the other hand, when I do something positive in the form of getting Beaumont Hospital under way quickly, he advises caution. I should be grateful if Deputy Boland would make up his mind and indicate precisely what role he thinks I should be following. If he wants me to be cautious and not get on with doing things then let him say so.
The activities of the Department of Health are at a record level. We have a nationwide programme of hospital building under way. This programme is being pursued as rapidly as possible and it will go a long way towards meeting the needs of the people for a modern hospital structure for the foreseeable future. As I mentioned, Tralee is under way and I hope Wilton will be commissioned this year. A major redevelopment of the Matter is under way. St. James's Hospital and Beaumont are under way. We are proceeding as rapidly as possible with the planning of Cavan Hospital and I hope to be able to make an important announcement about it soon. Letterkenny and Sligo are also in the pipeline. All over the country there is a massive building campaign of hospitals under way. Even from the prejudiced point of view of Deputy Boland, he has no case to make in regard to hospital building. The same applies in regard to every conceivable health facility. Health centres, homes for the mentally handicapped, sheltered work shops and a range of health facilities are being pushed ahead.
I deeply resent Deputy Boland saying that nothing is being done in the mentally handicapped area because that area is receiving full-time attention from me; indeed, I am very proud of what we are doing this year. It is misleading, false and prejudiced of Deputy Boland to suggest that nothing is being done in the mentally handicapped area. We have a building programme of £17½ million under way to try to make up for the neglect of previous years in so far as the provision of places for the adult mentally handicapped is concerned. Furthermore, as most Deputies who take an interest in these matters know, we have improved the allowance for families who keep their mentally handicapped children at home. I have also announced that we intend to provide a support service for families who wish to keep their children at home or who are waiting for a place. These are positive improvements in the area of mental handicap. If what Deputy Boland says in this regard was allowed to go unanswered, many people could be upset.
I am very disappointed with what Deputy Boland said about the all-party committee. That committee is under way. I cannot understand why Deputy Boland says he has heard nothing about it because all the members were notified last Friday that there would be a meeting this Thursday. Furthermore, every possible attempt was made by me and my staff to make sure that Deputy Boland was kept informed and I made every attempt to facilitate Deputy Boland.
: I pointed out that I was away last week.
: The meeting that was to be held last week was postponed for that reason. I went to great trouble to find out what Deputy Boland's convenience was in regard to the setting up of the committee. It is unfair and mean of him to say these things in the House.
Deputy Boland also referred to the Mental Health Bill. The preparation of this Bill, which is a complex piece of legislation because it deals with a difficult and sensitive area, took longer than I anticipated primarily because various people had to be consulted about it. The consultation process took longer than I anticipated. I now have the legislation in outline and I shall soon be putting proposals for the legislation to the Government. I am quite confident that the legislation will be circulated during the summer recess and that we will be able to take it in the next session.
On the question of the hospitals, Deputy Boland need not be unduly excited about them and he will not be in a position to make capital out of them. The manner in which hospital development is dealt with at all levels is a cause of worry and concern. There are a number of people who take attitudes about this matter and who indulge in activities in regard to it who seem to be unconcerned with the health of the people, not concerned with getting the best service for the people. In certain areas there is an undue preoccupation which nearly amounts to an obsession with the status of hospitals, not with the service and facilities being provided for the people, not with getting the best structure, but simply with the status of local hospitals. It becomes acute at certain times and in certain places. All I am concerned with is endeavouring to ensure that people get the best possible service, having regard to the resources available to us. There is no problem in regard to Tullamore and Monaghan. I have indicated that these hospitals are to be retained as county hospitals and that they are to be developed to the extent that is needed to service the people in these areas. I have asked Comhairle na nOspidéal, and they have agreed, to provide the level of staffing necessary in both hospitals to satisfy the needs of their areas. In spite of Deputy Boland's suggestion, there are no problems in regard to them.
As some Deputies who have studied this area know, there is frequently a conflict between the best medical answer and the best social answer. Sometimes these two conflicting pressures have to be reconciled. I am sure there is not great satisfaction for Deputy Boland to talk about the Roscommon situation. I said there is a problem in regard to the Roscommon situation. The federation arrangements will come into operation on 1 July for a trial period. All the problems involved have been settled and the federation arrangements will come into operation on 1 July with the proviso that the situation in regard to the maternity unit is still unsettled. Not everybody is thinking clearly in regard to this situation. The one thing that people should keep in mind in regard to maternity units is that we will never get to grips with the problem of eliminating mental handicap until we have proper maternity units. Anybody who becomes emotional about keeping a maternity unit in a particular area should bear that in mind. The onus of responsibility is on them if they insist that a maternity unit should be kept in a particular location when we know that the proper level of service cannot be provided in that place. It is not just a question of providing a service for the mother. Lurking behind the problem is the deadly question of mental handicap. If we do not make the right decision in regard to maternity units we can have an avoidable level of mental handicap. That is all I have to say on that.
The situation in regard to the maternity unit at Roscommon hospital is not yet resolved. I am endeavouring to resolve it but on one hand Comhairle na nOspidéal have taken a very strong stand and on the other, the Western Health Board have taken a different stand. If Deputy Boland can derive any satisfaction from the fact that these two major bodies, both pursuing the best interests of the people as they see them, take a different view of what should be done in Roscommon hospital in regard to maternity services, he is welcome to it. However, I shall try to resolve the situation as satisfactorily as possible. I have not done so yet but I shall continue trying. The rest of the situation has been resolved and the federation arrangements will come into operation as I said for a trial period. I hope they will work out satisfactorily and if they do not, we shall come up with some other proposal or suggestion for the benefit of the people of those areas.
In general—I appreciate there is a time problem and I do not want to take up too much time—I think impartial observers would acknowledge that in most areas of the Department of Health since I assumed responsibility for it there has been progress, that considerable developments have been undertaken and whereas all the things we might desire for our health services have not yet been achieved, nevertheless, in most areas if anybody asked me a question about any particular area I think I can point to either something having been achieved or at least having been undertaken. On that, my case rests.
: That a sum not exceeding £357,078,000 be granted—agreed?
: May I ask a question?
: Just one brief question. I have already said we have not much time.
: Is the Minister aware that in replying he did not deal with the suggestion that the health boards should have a review of their activities carried out as suggested by McKinsey nor did he deal with publications of details of the pay-related health scheme nor with the fact that he himself suggested in the House in December that the all-party committee should be a committee of the House——
: What are the questions?
: I must remind the Deputy that we have 40 more Votes to deal with and if the Minister were to deal with everything, we could take up all the time on this one Estimate.
: I understand the Deputy asked permission of the Chair to ask a question.
: Yes, a brief question.
: The question was whether the Minister omitted accidently to answer my query regarding the review of the health boards as suggested by McKinsey, to deal with my suggestion that details should be published of the proposed pay-related health insurance scheme, with the Minister's own suggestion last December that the all-party committee should be a committee of the House, which it is now not going to be, and the fact that two of the Minister's colleagues, whether he likes it or not, assured Roscommon County Council that the Minister had sanctioned the appointment of an obstetrician-gynaecologist at Roscommon, whether that was true or not, and whether the Minister was prepared to sanction the appointment of an obstetrician-gynaecologist and paediatrician at both Tullamore and Portlaoise hospitals.
: We are going back over the whole Estimate again.
: These are all the things the Minister has conveniently forgotten.
: That a sum not exceeding £357,078,000 be granted—agreed?
: Is the Minister going to answer that question?
: I am not aware of any particular question having been asked.
: Vote No. 44——
: I do not think we have agreed the Health Estimate yet.
: The Deputy will have another opportunity. Does the Deputy want me to put it?
: I understand that is normal.
: I understood it was agreed. I put it twice and nobody said he was not agreeing with it.
: Nobody said he agreed either.
: Does the Deputy want a division on it?
: If the Minister is going to be unco-operative——
: The Vote was already put twice and agreed.
: It was not agreed, Sir.
: If Deputy Boland did not say "agreed" that does not mean that the House did not agree. Vote No. 44——
: The Health Vote was not agreed, Sir.
: Do you want me to put it?
: Yes.
: I have put it twice. The Chair is going soft in his old age. I am putting the question : "That a sum not exceeding £357,078,000 be granted."
