Deputy De Rossa is in possession. He has 53 minutes.
Estimates, 1984. - Vote 47: Health (Revised Estimate) (Resumed).
Debate resumed on the following motion:
That a sum not exceeding £1,021,212,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 1984, 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 a grant-in-aid.
—(Minister for Health.)
In my earlier remarks I strongly criticised the whole approach to the development of the health service as well as the attitude of the present Minister who is the Deputy Leader of the Labour Party and who has a policy totally at variance with Labour policy in the trend he is pursuing at the moment. I indicated that the Government and the Minister were availing of the soft option in that they had decided to confront the old and the sick rather than the vested interests in the operation of the service, vested interests such as the medical profession, the pharmaceutical profession, the drug companies and the private hospitals. I also indicated that what was developing from the Minister's side of the House was a new form of socialism which appears to be a means test socialism, an attitude involving the application of a means test to all sections regardless of the rights or wrongs of the particular computation or the result of such a test. The most obvious example of that recently was the withdrawal of medical cards from some 120,000 students. Medical cards were withdrawn from a large number of young people between the ages of 16 and 25. I attempted to get the exact figure of how many students were involved and I was informed by the Minister it was not possible to produce such a figure and that that kind of information was not therefore available. It has, of course, been possible to produce a figure of 120,000 students and it is difficult to understand why the much vaunted computer the Minister has at his disposal can produce information which suits him but cannot produce information essential to Deputies in Opposition in order to counteract his arguments.
Another piece of information I sought which highlights the ludicrous approach of the Minister in regard to the withdrawal of medical cards from young people was the cost of means testing these young people who are deprived of medical cards. On two occasions I tabled a question to the Minister asking him to let me know the cost and I was told it would not be practicable to work that out. I tabled a further question to find out how much it would cost on average in general to means test any applicant for a medical card. Again I was told it was not practicable to produce that kind of information. I am fairly certain that if one were to take into account the time involved, the number of staff employed, the cost of stationery and so forth, we would be talking in terms at the very least of £20 per applicant. That is putting it at the lowest level. In a previous question I asked the Minister how much it would cost to inform 120,000 students that their cards were being withdrawn and I was told it would cost £50,000. That illustrates the way in which the Minister is continuing the ad hoc approach in the cutback. The ad hoc approach in the development of the services is now being applied to the actual cutback in the services.
Any society must be judged by the way in which it treats the old and the sick and if one were to apply such a guideline to the way in which the health services are being attacked by this Government and add to that the on-going long-term abuse of the old, particularly those who are lodged in psychiatric hospitals because they are old and no longer capable of looking after themselves, and when we are met every day of the week with housing cutbacks affecting the old, and even the young, the picture is not a happy one. I also raised with the Minister recently the case of a four-and-a-half year old girl whose parents were unemployed, who urgently needed her tonsils and adenoids removed and whose parents were advised that, unless the operation took place promptly, the child could suffer some permanent loss of hearing. By the time I put my question down the child had gone completely deaf. The Minister's reply on 13 March was that he was informed that should the case require urgent surgical intervention it would be carried out immediately. The fact is the operation has not yet been carried out and it would appear the Minister's interpretation of what is urgent is certainly not the same as that implied by the child's doctor and certainly not that which is implied by the hospital.
As far as I can see the Eastern Health board and the hospitals do not regard ear, nose and throat operations as matters for urgent surgical intervention. This is a clear case where a child entitled under statute law to health care, to the best care available, has been deprived of that care and is suffering as a result. We do not know yet when the operation will take place or to what extent that child's hearing will be restored when the operation is completed because the doctor is not in a position to guarantee that hearing will be restored. This is a situation where the cutbacks are having a very clear effect on the health of our young people. This case was brought to the attention of the hospital. She was placed on the waiting list last November but she has not been operated on yet and her hearing has gone completely. There are other instances as well.
The health boards are being driven into making petty and mean cutbacks in relation to old people. These people are subject to problems with abscesses or varicose veins and so on and the Eastern Health Board have insisted on cutbacks on the number of dressings that can be applied for these complaints. This is causing a great deal of distress. For the Minister to claim that his cutbacks are not affecting the quality of the health services available to the people in general is not accurate. I would ask him to think again of the way he is applying these cuts.
There is a need for urgent reorganisation of our health services. In the past the Minister committed himself to changing the fee-per-item system which means that every time a patient with a medical card visits a doctor the doctor is paid for that visit and every time a prescription is filled by a chemist the chemist is paid for that prescription. No advanced society attempting to provide a comprehensive service free at the point of delivery can do that with this fee-per-item approach. The Minister is on record as saying that he favours the capitation system whereby a doctor will receive payment for a patient on his books but that payment would not necessarily be related to the number of visits a patient makes. That would be a fairly dramatic change and would save considerable amounts of money if introduced.
Another area where savings could be made is in the administration of means tests. There is a considerable amount of time, resources and effort spent assessing people who may be eligible for particular services to which they are entitled. I would argue very strongly that the approach to the delivery of health services is tied very closely to a commitment to retaining private medicine. The only people who can gain from the continued split in the population — 40 per cent who have medical cards and the other 60 per cent who are bound to use the private medical schemes and others who pay out of their own pockets as they need the services — is the medical profession. Unless the Minister makes a calculated decision to do away with the whole concept of means testing for health services and confronts head on the vested interests, whose main interest is in selling health care as a commodity, we will have a ramshackle ad hoc, medical service forever and a day. Having a Labour Party Minister for Health in the Government one would expect that that would be the approach, but unfortunately to date the evidence is not there to raise any great expectations in that direction.
Another area which needs to be looked at is the drugs which are available. The World Health Organization have estimated that approximately 1,000 basic generic drugs would cover most eventualities in any health service. On the other hand, in this State there are something in the region of 15,000 drugs in circulation under various brand names and most of which are produced by multinational companies and promoted in a very lavish way through the doctors in private practice. I feel very strongly that the Minister should establish a list of these 1,000 drugs and insist that it is from this list that doctors prescribe for their patients and that the drug companies be asked to tender for supplies for health boards. That is an area where very large savings could be made. Again, the Minister will have to face very strong vested interests because there are huge profits made out of supplying drugs to our health services. Anyone who has ever had the misfortune to go into a chemist to buy any kind of drugs, whether on prescription or otherwise, will know the huge market there is at that level.
The other area I propose to talk about is family planning. The Minister promised some amendments to the Health (Family Planning) Act, 1979. It is my contention that the whole area of family planning is a question of the public health, and the health of the women in our society and their children. Members of this Dáil have no right to interfere with the choices made by couples as to what form of family planning they choose to use. The only function we have in the matter is to ensure that a wide range of family planning facilities are available throughout the State and where they are not available any amendment the Minister makes to the Act should ensure that they are made available. I favour the provision of family planning services through our local health clinics. In present circumstances this is the most obvious means of delivering family planning services to local areas.
The local health clinics could provide a much wider range of services in relation to women's health, which is at present ignored unless the woman has the finance to go to a private doctor to have various tests carried out. A local health board could provide services such as screening for breast cancer, cervical smear testing, rubella immunity testing and many other services. The basic service must be concerned with comprehensive and varied methods of family planning. It is not the function of the people in this Dáil to decide the methods any couple ought or ought not to use. All methods should be available, ranging from non-medical devices to what is called the natural family planning method. There are all sorts of methods which suit different people at different stages of their lives and it is not our function in this House to make moral decisions for anybody. It is up to us to ensure that public health is protected and comprehensive family planning is an integral part of that.
If the Minister introduces amendments which provide for the type of service I have talked about and does not attempt to make moral judgments for individuals, then he can count on my support and that of Deputy Mac Giolla for those amendments. If there is an attempt to carry on the window dressing introduced here in 1979 we will oppose it as strongly as we can inside and outside this House.
Drug abuse is an area of concern which makes newspaper headlines almost every day of the week. The problem has not developed overnight but has been growing over a number of years. Many of us involved in public life warned various Governments over the years about the growth of this problem and that nothing worthwhile or specific was being done to tackle it. There is a need for the implementation without delay of the task force recommendations which the Government received last November. The Minister has indicated that steps are being taken to implement them but the perception of people outside this House is that not enough is being done to tackle the problem. This has given rise to street demonstrations in recent months and in some instances the harassing of individuals alleged to be drug pushers. It has also led, apparently, to activities of a paramilitary nature. A number of people have been shot and attempts have been made to kidnap several people. This is leading to even greater frustration on the part of parents who are genuinely concerned about the problem of drug abuse.
I would emphasise that the kind of vigilante activity which has occurred in some instances — not all — is not a solution to the problem. There can be no overnight or easy solution. It requires the co-operation of parents and the Garda at local level, as well as the co-operation of teachers in schools. It also requires the provision of resources by the Government for the treatment of drug addicts and a positive development of social and economic policy which would eliminate the despair which largely leads to the use of drugs by young people.
A study last year indicated that the greatest problem of drug abuse exists in those areas which are most deprived socially. That is not to argue that drug abuse does not occur in middle class or upper class areas — it certainly does — but its greatest concentration is in areas where there is most social deprivation. Many young people involved in drug abuse are also involved in petty crime in order to pay for their habit and this is leading to further frustration and disenchantment among people in areas where there has been for a long time a high degree of alienation from the establishment, the Garda and so forth.
One of the task force recommendations concerns the expansion of the drug squad. That is a very clear and unambiguous recommendation which has been accepted by the Government. I would be the last to argue that the expansion of the drug squad would lead to the solution of the problem, but it is an indication of the unwillingness of the Government to tackle the problem seriously and provide the necessary resources that a few months later they say it is not proposed to expand the squad immediately and that if the Government feel greater resources are required then they will be provided. That is a very clear back off from the acceptance of the recommendation. If we examine the progress which has been made on the recommendations of the task force, we see a trend towards backing off from those recommendations. We are told in reply to questions here that various discussions are taking place and various decisions are being made but we see no concrete evidence of progress.
One recommendation concerns a part of my own constituency, Ballymun, regarded as a high risk area, together with Dún Laoghaire, sections of the north inner city and sections of Cork. It was recommended that various State agencies should come together and decide how best their services could be utilised to assist in beating the scourge of drug abuse. To date, almost six months after the acceptance of those recommendations, there is no clear evidence in Ballymun of any concrete result. There is no evidence that any of the agencies concerned have come together to discuss how they can best make an input to the solution of the problem of drug abuse in the area.
Therefore, the Minister must make a serious endeavour to convince people outside that he is genuinely concerned about the drug problem. I know he is genuinely concerned about that problem but he must make that clear by way of taking positive action to tackle the problem at all the various levels. Obviously, the area of supply is one, but if demand ceases to exist supply is no longer a problem. Therefore, we must concentrate on the long-term question of eliminating the demand for these drugs while in the short term we must deal with the situation of those young people who are addicted to drugs. We can only do that by providing adequate resources to enable treatment facilities to be expanded. We must ensure that those young people who are dependent on addictive drugs and who find themselves before the courts are not lodged in prison cells without there being any hope of treatment for them. During their incarceration they come into contact with people who have been found guilty of other crimes with the result that the drug addict may well leave prison more proficient in ways of getting money with which to buy drugs. I am asking that practical steps be taken, steps which will convince the people of this city and of other areas where there are serious drug problems that the whole question of the treatment of addicts and of the apprehending and imprisoning of pushers is being dealt with to the greatest extent possible.
We must concentrate on eliminating the demand for addictive drugs, a demand that arises by and large from the sense of despair experienced by young people in not being able to fulfil themselves as a result of the social conditions in which they live. In many cases of drug addiction the people concerned began taking drugs when they found they had no job prospects and very often these are people who have only had a very poor education. I appeal to the Minister to concentrate on that aspect of the problem.
I urge the Minister, too, to reverse the policies he is pursuing now and to face up to the vested interests I have named — the medical profession, the pharmaceutical profession, the drug companies and the private hospitals. These are the areas in which huge amounts of money are being wasted. It is a statistical fact that for almost the same expenditure of GNP in Britain a comprehensive health service is provided free of charge whereas here this is available to only 40 per cent of our population. Clearly, then, there is a wastage of resources and there is a necessity to locate the areas of that wastage. I have indicated where I think they are and it is for the Minister as a socialist and as Minister for Health to tackle those areas.
It might be worth reiterating that the purpose of private medicine is profit. In order to highlight that I shall quote a gentleman by the name of Jack Massey who at one stage was chairperson of Kentucky Fried Chicken in America but who resigned that position to become head of the hospital corporation of America. He said that the gross potential in hospitals was unlimited, that it was even better than that of Kentucky Fried Chicken. I appeal to the Minister to tackle the private medicine lobby and to set about providing a public health service from the resources provided by the taxpayer.
Before commenting on the quotation given by the Deputy one would need to establish what the gentleman's remuneration was while he was with Kentucky Fried Chicken. Perhaps he just went to a better job.
In any event we may take it that there was more money in private hospitals.
The Irish have a health service of which to be proud. Thanks to the commitment and foresight of our predecessors — politicians, professionals and administrators — this country has a health service comparable with those of the richest countries in the world. Many countries envy the extensive system of primary care, the sophisticated hospitals and trained personnel that are at our disposal. The rate of infant mortality, now at a record low level, mortality rates and life expectancy at different ages, all compare favourably with standards enjoyed in other countries. This was not the case 35 years ago, before a comprehensive effort was made to improve the health services.
In recent years the health services have been able to meet the growing demand for services resulting from the increase in population, rising expectations for medical care and advances in medicine. The health services have for the most part avoided the kinds of problems which have affected other services in this country where demand has exceeded supply. Much of this has been achieved by increased efficiency. Health board hospitals, for example, with a slight reduction in beds increased their throughput of patients by more than 60 per cent in the period 1970 to 1981.
The scope of the health services is unusually wide in Ireland, more so than in other European countries. It includes sophisticated medical treatment in hospitals, family medicine in the home and doctor's surgery, long-term care for the elderly and handicapped and, less obviously, a wide range of welfare services to assist people with physical, mental and social disabilities. The health service is responsible also for standards of food and medicines, the control of tobacco and alcohol advertising and for the promotion of health education. This permits health and health-related problems to be tackled on a broad front.
The organisation of these different activities into an effective and efficient service to promote the highest level of health is one of the major challenges in the health services at present. Since taking up office I have been particularly concerned with a number of specific aspects of the health services. One of these is the whole concept of obtaining value for the money which is spent on these services. The rapid increase in expenditure on these services is a matter of concern and there now seems to be a general realisation that the resources which we can make available for health are limited. It is therefore more vital than ever before to extract the maximum benefit for every increment of cost which is incurred.
One of the major problems facing the health services is how to balance an infinite demand with limited resources. Very few countries will be in a position to maintain the level of increase of spending on health services which has taken place in the past ten years. We are no different in this respect. The current year's health allocation is less than the Government would have desired but is the most that could be given having regard to the Exchequer position. As a result I recognise that all health agencies will face difficult decisions in containing expenditure within their approved levels.
The current year therefore will see some inevitable reductions in expenditure levels. The bulk of this reduction will fall on institutional services which account for over 70 per cent of total expenditure. In achieving the reductions necessary all health agencies have been advised that services for those most at risk should be protected to the maximum extent and that a switch should be made wherever practicable from institutional care to care in the community.
There has been a significant degree of criticism in recent years regarding the manner in which health resources, financial and personnel have traditionally been deployed. The thrust of these criticisms is that far too high a proportion is consumed by hospitals and other institutional centres, leaving community services to make do with the remainder.
The absence of extra funds for new developments means that none will be possible unless resources can be transferred within the present levels of allocation. It is essential that all services should now be subject to a much more searching and ongoing examination to identify all opportunities for the modification of services, to improve both their effectiveness of delivery and their economic efficiency.
Given that it will be absolutely essential to maximise levels of cost effectiveness, we have already taken a number of important steps to see that value for money is obtained across a broad range of services. For example, a number of studies were carried out on supplies, energy, transport and housekeeping and the recommendations for improved practices set out in these particular reports have now been circulated to the health agencies.
Certain other services, notably the procedures relating to patient admissions to general hospitals, are currently being examined to ensure that unnecessary admissions to hospital do not take place. New management information systems, now being introduced by the major health agencies, will be of inestimable value and assistance to managements, both local and central.
The management information that will be produced by those systems, for example in the costing area, will greatly improve the quality of analysis and decision making. I think it is fair to say that the rapid growth in non-capital expenditure in the past decade on the health services has meant that there is room for greater economies and better utilisation of resources. These studies which I have mentioned, the critical evaluation of services, the new management systems being introduced by the various major health agencies, can only assist the Department and the agencies to deliver services in an efficient way. Ultimately they should result in greater value for money being obtained for every pound spent on the health services.
One other area which is being examined in the current year is the question of supplements to basic pay which cost over £100 million in 1983. While I accept that the major portion of this amount was in respect of payments for night and week-end duty it is imperative that a reduction in this area is achieved. Failure to do so could result in the loss of jobs or reduction in important services. We are very fortunate in this country in having an exceptional and strongly motivated staff providing our health services. We have received a most responsible level of co-operation from these staff in effecting savings and I am confident that with their assistance services will be maintained at an acceptable level. The measures being taken in regard to cost containment, while important, are just one part of a more general strategy to ensure that resources are used to the best effect.
We must now move from this stage to a more fundamental questioning of some of the services and procedures which have traditionally been regarded as essential elements of the health care system. This is allied to service evaluation, the process of continuously reviewing the justification for each area of expenditure to enable conscious decisions to be made on each element of the services provided. This process is an inherent part of good management but it will become even more relevant in the future if, as we must now assume, the current restrictions on public spending are not simply a transient phase.
The need to control spending on public services is not simply the pre-occupation of politicians and public servants. Daily we hear the exhortations for lower taxation or more lenient treatment of this or that group. Simultaneously, there are requests and demands for new services, extensions of existing services or eligibility for services, many seemingly based on the false notion of a bottomless public purse. As politicians we have a responsibility to inform the public of the realities of the situation. We must have the courage to tell them that it is not possible simultaneously to reduce the yield from taxation and, on the other hand, provide more public services. Quite simply, the equation will not balance.
I have also been concerned with the drugs related aspects of the health services. This responsibility comprehends both the legitimate use of drugs as well as their abuse and the various controls which need to be exercised in both areas.
Drug abuse is one of the most serious problems facing our community today. In the last few years the nature of the drug problem has changed in this country and it has had a dramatic growth. The nature of the problem has changed in that most addicts are now abusing heroin which is a recent phenomenon in this country. The social profile of the typical abuser has also changed. The drug problem, which is mainly confined to the greater Dublin area, now affects young people particularly, without any reference to intellectual or educational attainment. No social class and no district in this area is exempt. A remarkable trend in recent years has also been the increasing number of adolescents who begin with immediate abuse of ‘hard' drugs rather than by way of the long established procedure of graduating from the so called ‘soft' drugs.
It is estimated that there are 1,500 heroin addicts in the Dublin area and probably twice as many more experimenting with the drug. The available evidence from the drugs advisory and treatment centre in Jervis Street shows that in June last 260 patients attended the centre and of these 196 were abusing heroin. Sixty of those attending were new patients. As there tends to be a three to four year time lapse between a person's first contact with drugs and when treatment is sought these figures from Jervis Street obviously would not reflect the full extent of the current problem.
The impact which heroin abuse has on our community is very significant particularly in terms of human suffering and of crime. Heroin addicts almost invariably have to resort to crime to obtain the money to feed a habit which can cost from £100 to £150 per day. It is also evident that many addicts eventually turn to drug pushing to help feed their own habit and this in turn spreads the growth of the problem. The number of persons convicted of unlawfully supplying controlled drugs increased from 24 in 1981 to 99 in 1982. The number of drug seizures made by the Gardaí increased from 1,204 in 1981 to 1,873 in 1982, an increase of 56 per cent. The most disturbing factor in this area is the increase in the amount of heroin being seized, which increased from 170 grammes in 1981 to 1,264 grammes in 1982. The largest single seizure made was 364 grammes in Dublin.
It was in the context of this major and growing problem that the Government decided to establish the special governmental task force of Ministers, which was the first of its kind. The task force were asked to review and report on the question of drug abuse with particular reference to the inner city area of Dublin. They carefully examined all submissions received including those received from the health boards, as well as two recent reports on the incidence of drug abuse, both of which confirmed that the extent of heroin abuse is very high. There were many useful suggestions made in the submissions and these helped the task force to frame many of their recommendations. Among the areas which were examined in detail were the range of measures aimed at preventing the importation and distribution of illicit drugs, the provision of comprehensive drug education programmes as an integral part of school curricula, the introduction of a youth and community development strategy, and the adequacy or otherwise of the treatment and rehabilitation facilities available to drug abusers. The task force in their consideration of these areas had discussions with the experts dealing with these facets of the drug problem.
The Government appreciate that the drug problem cannot be eliminated overnight. However, its growth in the Dublin area must be halted and its spread to the provinces prevented. I am confident that with the implementation of the recommendations of the task force the technical problems experienced by the Garda in the past have been overcome and the spread of drug abuse through the country can be arrested and contained.
Another of my responsibilities as Minister of State is measures to combat infectious diseases. My predecessor in office, Deputy Fergus O'Brien, gave particular emphasis to the expansion of vaccination and immunisation to protect the health of infants. The low level of whooping cough vaccination is particularly disturbing. While the target level to ensure an acceptable level of immunity is 70 per cent of young children, vaccination rates in the seventies fell to as low as 32 per cent. In other words, only three out of every ten children were being adequately protected from the disease. Not surprisingly, the incidence of whooping cough rose, alarmingly rising to 1,000 reported cases in 1982. This is no less than an epidemic. Since the disease can permanently damage children, and in some cases causes death, something had to be done to encourage parents to bring their children for vaccination. The 11 deaths from the disease between 1973 and 1982 were 11 deaths too many.
Parents who may have feared that the vaccine might damage their child, may be reassured by the work of the Royal College of Physicians in Ireland. Surveying the international information on whooping cough vaccination, the college have drawn up a list of the contradictions for vaccination which has since been circulated to general practitioners and medical officers to assist them in deciding whether or not to administer a vaccine in a particular case. It is clear that the damage caused by the disease far outweighs the risks of vaccination.
The programme to promote vaccination designed by the Health Education Bureau aims at increasing the awareness of parents and the medical profession of the benefits of immunisation in preventing disability and death. The public is being alerted by means of advertisements on television and radio and many of you will have seen or heard the extremely hard hitting advertisement about whooping cough.
A special educational and informational ‘kit' on vaccination and immunisation has been circulated to each doctor in the country. The ‘kit' consists of posters for display in the surgery and a leaflet setting out details of the Department of Health's programme of recommended vaccination and immunisation.
Poor rates of vaccination against polio are also causing concern. The occurrence of five cases of polio in 1977 and one case of the disease in 1980 and 1982 was the direct result of the low level of vaccination. There is no need to remind the House of the devastating effects of this dreadful disease. We cannot relax until every child is vaccinated against polio as a matter of routine.
I will continue my predecessor's efforts to ensure that every child is assured the right to health from its earliest years. About 40,000 cases of measles occur each year and the side effects of the disease place demands on the health services, both in the short and long term. The Minister has announced that he is planning the introduction of a measles vaccination programme, to begin hopefully in 1985. A vaccination programme will reduce the amount of illness caused to children by this disease and the consequent demand on the health services for expensive medical care.
I am particularly concerned with the suitability for human consumption of meat and milk at the point of sale. The Minister for Agriculture shares this responsibility.
Health boards arrange for analysis of food samples at the retail level including the monitoring of milk and milk products for antibiotic residues. It is hoped that products will soon be monitored for both hormone and antibiotic residues.
Concern has been expressed about the widespread use of antibiotics in farming and the danger that human diseases will become increasingly resistant to some antibiotics. The Department of Health commissioned an in-depth review by the Food Advisory Committee. Detailed controls, which include prescription control for all antibiotics, together with monitoring systems have been recommended by that committee and are being considered in both Departments. As the Minister indicated, the proposed measures promise to be up-to-date and effective. Of course, in addition to checking for compliance with these controls by sampling at the retail level, it will be necessary to ensure that they are observed at the point of source, that is at the slaughtering stage.
Recently, the adequacy of controls on the sale and use of hormones and antibiotics in animal husbandry has been queried. Controls already exist under the Poisons Regulations 1982 and under regulations administered by the Minister for Agriculture. I understand that he is moving to restrict sale of certain of these products to prescription only.
Prior to 1980 community ophthalmic services for all eligible persons were provided by the health boards through clinic sessions held by ophthalmologists who were paid on a sessional fee basis. When spectacles were prescribed they were supplied by certain opticians who were the official contractors to the health boards. Each community care area of the health board invited tenders, and contracts for the supply of spectacles were awarded on an annual basis.
At the beginning of 1980 the new sight testing scheme came into general operation. Under this scheme eligible adults and adolescents who require a sight test are issued with an authorisation by the health board to attend an optician or ophthalmologist of their choice from a panel who have entered into an agreement to provide services on behalf of the health board.
When spectacles are prescribed they can be supplied by an ophthalmic optician, ophthalmologist or a dispensing optician on the health board panel. The fees for sight tests and the prices for spectacles are the same as those paid under the Department of Social Welfare's optical benefit scheme. The sight testing scheme is in addition to the clinic based service provided by ophthalmologists who continue to provide a service as before but whose work-load of adults has been considerably reduced by the introduction of the sight testing scheme. While the full development of the community ophthalmic and sight testing services require additional resources, there are no great problems for children in obtaining treatment, and spectacles, if required.
Screen testing of children for hearing defects is carried out in the course of developmental paediatric clinics and by specially trained public health nurses. Where hearing loss is suspected the child is referred to an ear, nose and throat surgeon or an audiologist for confirmation of the diagnosis and, if necessary, to the National Rehabilitation Board for the supply of a hearing aid.
Visiting teachers of the deaf are employed by the National Rehabilitation Board to advise on the care of pre-school hearing-impaired children in co-operation with visiting teachers of the deaf employed by the Department of Education.
An eligible adult with a hearing difficulty can be referred by his doctor to an ear, nose and throat specialist, or, if the doctor considered a hearing aid is necessary, to the local health board. The health board arranges for the supply of a hearing aid through the National Rehabilitation Board. The National Rehabilitation Board provide assessment of hearing loss throughout the country. They operate permanent clinics in Dublin, Cork and Galway, and regular clinics in several other centres. The hearing aid service is functioning satisfactorily.
Debate adjourned.