I should begin to reply by saying that I appreciate the generally constructive and helpful attitude of most Deputies towards this Bill. I do not suppose that I can legitimately complain if a number of Deputies availed of the debate on this measure to range over the health services in a very broad way. It indicates that individual Members are on the one hand very knowledgeable about the health services, their scope and details of their administration and also that they are concerned that our health services should be as near perfection as we can make them and that they should be continually pressing for improvement in one area or another. A number of very good points were made in the discussion. The Chair was reasonably lenient in the scope allowed to Deputies and I doubt that I will be permitted to reply in detail to various points made.
The first issue which arose in the minds of most Deputies was the income ceiling or limit which will be as I have already indicated on a number of occasions, £5,000 or thereabouts. We must always keep in mind here that it is essential for efficient operation of this new service that the same maxima will be applied on both the social welfare side and the health side. There would be almost insurmountable difficulties and complications if we did not have the same ceiling for both. On the social welfare side the ceiling is fixed at approximately one and a half times average industrial earnings. The reason for that formula being used is to ensure that the overwhelming majority of wage and salary earners are included in the scope of social insurance. That more or less decides the ceiling for it. I have already pointed out also in connection with the social welfare legislation and with this legislation that the final figure will be determined before 1 April and will be settled and brought into operation by regulation.
So far as the health side is concerned it is important to remember that the ceiling and indeed the income generally which will be used as a basis for qualification will be the income for the preceding year. In other words, the income limit for eligibility purposes in the year commencing 1 April 1979 will be the income for the preceding year, the income earned between April 1978 and April 1979. That will have the effect of some easement in so far as people at the upper limit are concerned. A decision regarding their eligibility will always be based on their income in the preceding year. The situation in regard to manual workers with incomes in excess of £5,000 has been stressed on a number of occasions during the debate but the only point that can be made in the case of this category is that they now become eligible to pay for their consultant services.
Deputies know the history of this matter and I think any fair-minded Deputy would have to accept that what we are doing now is a very considerable advance on the complicated anomalous situation which prevailed up to now where you had a limit of £3,000 and superimposed on it a situation in regard to manual and non-manual workers. The whole thing had got into a practically unintelligible state in recent years. These proposals bring clarity and certainty into the situation. In future there will be clear-cut categories of persons entitled to certain services. That is a distinct advantage and a definite advance.
The higher paid workers—and I think I am entitled to call anybody earning more than £5,000 a year a higher paid worker—will not be left unaided as regards these consultant services. With the full co-operation of the Voluntary Health Insurance Board we will be able to provide a very satisfactory method whereby the people earning over £5,000 a year will be able to provide against any liability they may incur regarding consultant services.
Deputy Boland asked me if the new package which the VHI Board were bringing in would be open to the general public and I am very glad to say that it will. I speak about it principally in connection with manual workers earning over £5,000 a year because it is of particular interest to them. But the situation will apply which has always applied, namely, that the package will be open to every member of the general public. The VHI will shortly be publicising their new scheme and they will now be providing the following benefits: maternity benefit to cover a range of payments for consultancy fees; relaxation of the existing rules governing payments where miscarriages are involved; they will provide for special nursing; there will be relaxation of existing rules governing payment in respect of day surgery and the introduction of a new benefit dealing with cases requiring convalescent care. In addition, for a limited period the existing entry restrictions regarding previous medical history will be lifted. There will be no waiting period in regard to eligibility for benefit and no entry age limit, which is very important. The age loading for subscribers over 60 will be discontinued. Finally, and perhaps equally important, is the fact that anybody who wishes will be able to pay premiums on an instalment basis.
I strongly urge that everybody in employment, certainly in the upper regions of income, should without delay get in touch with the VHI and study the package which will now become available. I have been urging the trade unions to draw the attention of their members, particularly those with over £5,000 a year, to this new package.
I have indicated to them that the VHI board will be prepared to organise discussions and seminars, and I believe that if the wives of most of the higher paid workers were to become fully aware of the package the VHI are now offering we would have a major influx of higher paid workers into the VHI, which is what we are aiming at. It would be a very attractive package. It would provide considerable benefits and I would hope that it will be very widely availed of by the trade union movement and by salary wage earners generally. The package has not been fully publicised yet, but I believe that it will be possible for families to provide against the cost of consultancy services for as little as £11 per annum for each adult and less than £4 per annum for each child. If you take those figures and allow for the fact that the full premium payable to the VHI board is available for income tax purposes, this is a bargain which is being offered. I repeat that I asked the trade union leadership in particular to bring these services to the attention of their members. I urge strongly that they would avail of them and get into the VHI. Any member of the VHI will agree with me and confirm that it is a most satisfactory organisation to belong to. It gives a very efficient service. When you submit your claim it is dealt with in a most expeditious manner and with the minimum of bureaucratic inquiry.
Some doubt was expressed here about the possibility that difficulties might arise in the allocation of hospital beds and that there might be some question that fee-paying patients would procure an advantage over non-fee-paying patients. I assure the House that any such fears are groundless. These matters have been discussed with the medical organisations and the health board managements, and the House can be assured that there will be no change whatever in the existing situation. Beds will be allocated in the public wards entirely on the basis of medical needs. This will be the governing criteria and it will be impressed on hospital managements, health boards and voluntary hospitals that this is to be the situation. Not indeed that anybody need fear that there will be any question in any of our hospitals of anything otherwise prevailing. The guiding principle will be that patients will be admitted to hospital, as they have always been admitted to our public wards, on the basis of medical priority.
Deputy Boland queried the figures of yield from these new health contributions, and perhaps I unwittingly contributed to some misunderstanding here. It is calculated at 1 per cent at existing rates and will bring in about £30 million in a full year. In 1979 the 1 per cent will not be operating for a full year, but only from April to December. Therefore, at the £5,000 a year ceiling, 1 per cent in that April to December would bring in £22.5 million. To that must be added what the existing flat rate contributions will bring in between January and March, and that will be a figure of £4.1 million. Therefore, the total estimated income for 1979 will be £26.6 million.
Some Members have expressed concern about the situation in regard to farmers. The new situation will be that farmers will pay health contributions the same as any other section of the community, on a pay-related basis. The upper ceiling will be related to a £60 valuation and valuations under £60 will be calculated pro rata, and the 1 per cent will be a figure so calculated. There will be improved machinery for the collection of the health contributions from the farming community because the existing situation is not entirely satisfactory. The health board records indicate that the average collection rate is about 70 per cent, though the figure may be a little higher than that. Many persons have been billed and therefore contribute to the overall total, though because they are medical card holders they would be entitled to exemption. The new system will apply fully to the farming community and every effort will be made to perfect the system of collection.
Some Deputies, in particular Deputy O'Connell, referred to the question of drugs. This is a very important element of the whole administration of the health services. First of all, Deputies will have seen that I was at last able to promulgate the necessary regulations to give effect to the Misuse of Drugs Act last week. Unfortunately, these regulations were a long time in course of preparation. They are very complicated and complex, and they involve long, arduous and tedious discussions with many interests, all of whom had to be consulted and whose advice had to be obtained. Now they have been promulgated and the Misuse of Drugs Act is now fully operative, and we hope that it will be effective in controlling abuse of dangerous drugs which exists in our community.
Apart, from dangerous drugs, there are the normal, ordinary drugs and there is a fairly widespread agreement that we are as a community far too dependent on drugs and medicines. The marvellous advances that have been made in the pharmaceutical industry in recent times are, of course, a boon to mankind. They now enable all sorts of illnesses and diseases to be cured and cleared up which previously were, if not incurable, very nearly so. There has undoubtedly been a marvellous improvement in general medicine as a result of discoveries of the pharmaceutical industry. However, that very improvement has brought its own danger in its train. Some people are inclined to think that there is no illness, disease or defect that cannot be cured if one has access to the right drugs. Of course we know that that is not so. Therefore it is important to maintain a balance in our approach to drugs and medicine, to realise their value and at the same time realise their limitations.
In general, the GMS relies to too great an extent on drugs and medicines. We are making a consistent effort to curtail the excessive use of drugs and medicines. At the same time we do not want to interfere with the legitimate interests of the patient, or the doctor's right to prescribe what he in his discretion considers to be appropriate. With the full co-operation of the medical profession we are introducing a number of measures which will reduce the cost of drugs in the GMS and will help to reduce the dependence of the population in general on drugs and medicines.
For the information of the House, a very important seminar will take place on Friday of this week. It is being organised by the Irish Medical Association in co-operation with my Department and the Health Education Bureau and it will be entitled "The Alternative to Drugs". It will seek to get the message across that when one visits a doctor it is not always necessary to come away with a prescription for a drug or medicine. Very often a doctor can meet the needs of a situation in a different way and the patient should not feel cheated or deprived if having visited a doctor he does not emerge with a prescription to be brought to the nearest chemist. I hope this seminar will perform a useful service in this area. Side by side with the organising of that seminar, the Health Education Bureau will initiate a campaign along the same lines, to encourage a more conservative approach to medicines, a campaign which will be designed to get the message across to the general public that drugs and medicines have their legitimate uses but that it is socially wrong and bad medicine to rely too much on them.
One criticism made by Deputy O'Connell is entirely without foundation and if he thinks about it he will realise that it is not a valid criticism. Deputy O'Connell said that by bringing in this legislation we are establishing a massive bureaucracy. We are doing exactly the opposite. The combined effect of this proposal for a new system of collection of health contributions and the new pay-related system which will apply in social welfare, will be a very considerable reduction in administration and bureaucracy. From now on there will be only one clear-cut specific percentage deduction, made by the employer, and employers will know exactly who they must make the deduction from, and overall there should be a much tidier administrative system. That is certainly one of the objectives. Anyone who studies the thing in detail will realise that there should be very considerable savings all round in administrative costs when these new systems are introduced.
Deputies are aware of, and most Deputies will support, my emphasis on health education and preventive medicine. Here, as in most EEC countries, it is recognised that this is ultimately the only way to bring the cost of health services under control. It is only by persuading more and more people to take care of their health and to avoid the sort of life style that creates ill-health, that we can meet the very heavy cost of our health services in the future without placing an undue and intolerable burden on the taxpayer. In relation to health education we are continuing our efforts in regard to smoking, and Ash Wednesday this year will be proclaimed a national "no smoking" day. With the assistance of the Junior Chambers of Commerce throughout the country we hope to have a major "no smoking" campaign throughout the country on Ash Wednesday. More details of that will be announced in due course but that is one of the efforts we have in mind for the immediate future in our campaign against cigarette smoking.
Increasing attention has been directed to the problem of alcoholism. There was an interesting seminar recently which most Deputies will have read about where some of our experts gave their views about the incidence of alcoholism and the dangers involved in excessive drinking. A different situation prevails here than that in regard to smoking and it requires a different approach. We have to develop our services in relation to alcoholism. We have, I regret to say, a fairly high number of people who suffer from the disease of alcoholism and we must increase and improve our services for this very vulnerable section of the community. We must also give much greater attention to prevention in this area. Nobody would suggest that we embark on totally restrictive campaigns. We must curtail and limit the abuse of alcohol, to try to eliminate excessive drinking and if at all possible encourage widespread support for the concept of moderate drinking. Most people would agree that alcohol is one of the benefits available to mankind, but it is only a benefit if it is sensibly and moderately used. That must be the keynote of our approach to alcoholism and excessive drinking.
Many other issues would naturally arise in the course of a debate of this sort and one is tempted to go on and turn this debate more or less into a general resume of the activities of the Department of Health. However, I intend to resist that temptation. I would hope that I have dealt to their satisfaction with most of the points raised by Deputies.
Before I conclude, I wish to comment on one point raised during the course of the debate. This was the suggestion that we should have health programmes on radio and television. I am glad to be able to inform the House that we have made and are making considerable progress in that regard. It is clear to most Deputies that the power of television in this area is enormous. It is a very effective medium for getting across all sorts of messages. The RTE Authority and the Department of Health have a mutual interest in this field. People are interested in their health and, therefore, good health programmes could be good television. I think that concept is accepted in RTE and we have had many useful and helpful discussions involving the Department of Health and the Health Education Bureau. In the months ahead we can expect quite a number of useful and beneficial programmes in the field of health on radio and television. I am glad to be able to mention that to Deputies and also to say that the attitude within RTE is entirely helpful. There are many difficulties involved in this, but in regard to attitude I may say that there is nothing but helpful co-operation forthcoming. A great deal can be done and enormous benefits can ensue from co-operation between the Health Education Bureau and the RTE Authority.
