Dáil Éireann díospóireacht -
Tuesday, 3 Dec 1985

Vol. 362 No. 5

Health (Amendment) Bill, 1985: Second Stage.

Minister of State at the Department of Health (Mr. Donnellan)

I move: "That the Bill be now read a Second Time."

The purpose of this Bill is to enable charges to be made by health boards for hospital inpatient and outpatient services on persons in respect of treatment of injuries received in road traffic accidents when the injury is caused by the negligent use of a mechanically propelled vehicle in a public place and where the person has received, or is entitled to receive, damages or compensation in respect of such accident.

The principle of recovering the costs of the treatment of road traffic victims can be traced back to the Road Traffic Act, 1933, and the most recent provisions were contained in article 6 (3) of the Health Services Regulations, 1971, which were made under section 72 of the Health Act, 1970. These regulations were challenged in the Cooke v. Walsh case and the Supreme Court judgement of 16 December 1983 declared that the regulations were ultra vires the power of the Minister and were void.

When the Health Act, 1970, was debated in this House the then Minister for Health made it clear that persons who received damages or compensation for injuries received in road traffic accidents would be required to pay for hospital services received in respect of their injuries. He indicated that this would be covered in regulations which he intended to make under section 72 of the Act. The Act was passed and subsequently the provisions made in article 6 (3) of the Health Services Regulations, 1971, were availed of to make such charges until they were declared ultra vires by the Supreme Court in December 1983.

The provisions which I have now brought before the House provide specific authority to enable health boards to reintroduce charges for hospital services provided for persons who receive damages for injuries received in a road traffic accident. Such charges will then be admissible in claims for compensation before the courts. These will be decided ultimately by the courts and the damages awarded, which would include provision for the charges, would be payable by the insurance companies.

I have made specific provision in the Bill for the waiving of the whole or part of the charges in cases where the compensation payable to the injured party has been reduced by the courts by reason of contributory negligence of such person or where the amount of damages is insufficient to meet the charges. This will protect the injured person from any hardship which might arise in meeting the charges.

As to the detailed provisions of the Bill itself, it is a short Bill containing only four sections. Section 1 sets out the definitions used in the Bill and those definitions are mainly contained in other pertinent legislation. Section 2 (1) gives specific power to health boards to make charges for hospital inpatient and outpatient services on persons injured in road traffic accidents who have received, or are entitled to receive, damages or compensation in respect of the accidents. The charge payable is not specified but would normally be the average daily cost per bed day in the hospital concerned. This will vary depending on the hospital involved.

I should make it quite clear at this point that there is no retrospective provision in the Bill and consequently these charges will arise only for cases where the injury occurs after the enactment of this legislation. Services provided in respect of injuries received prior to the enactment of this legislation will be dealt with in accordance with the existing provisions of the Health Acts.

Section 2 (2) allows health boards to waive the whole or part of the charge raised where the amount of damages received is either insufficient or has been reduced by virtue of contributory negligence of the injured person. This provision is necessary in order to prevent hardship on the injured party. Sub-paragraph (b) of this subsection is a technical provision which enables the courts to disregard the discretion of the health board to waive charges in determining the amount of damages to be assessed.

Section 3 simply provides for recovery of sums due under section 2 and, as many of the court cases on road traffic injuries take a considerable time to resolve, it also provides that charges shall accrue on the date on which damages are paid or on the date on which the services were provided whichever is the later. Section 4 provides for the short title, collective citation and construction.

In recommending this Bill for a Second Reading I want to emphasise to the House: (1) charges have been levied in these circumstances since 1933; (2) insurance companies have been paid premiums to underwrite these risks; (3) the Exchequer should not be called upon to bear the costs of negligent drivers, and (4) adequate precautions have been taken to ensure that no hardship will accrue to the injured party.

Loss of income from charges in respect of road traffic accident cases since the Supreme Court decision has aggravated the difficult financial position of health agencies. The reimposition of these charges is therefore essential. It is currently estimated that the charges to be levied could provide income of up to £4 million per year.

Dr. O'Hanlon

As the Minister pointed out, this legislation was introduced because of a decision of the Supreme Court in 1983 in the Cooke v. Walsh case brought by the father of an infant who was injured and damages amounting to £757,538 were awarded to the child out of which health board expenses amounted to almost £100,000. The High Court decided in favour of the insurance company and then the Supreme Court took the view that it was ultra vires for the Minister to impose these charges under the various health Acts between 1947 and 1970. The plaintiffs in the case also maintained that this law was unconstitutional and that was not tried in the court because they succeeded on the ultra vires claim, so now we have this legislation.

While we are not opposing the legislation it is disappointing that the Minister has not looked at the area of the health services and their relationship to insurance companies and the question of payment in this type of case, to see if some other way might not be found to cut the cost to the citizen. Irrespective of whether the health services or the insurance companies pay the cost, it is always the citizen who pays through higher insurance premiums or through higher taxation to provide the health services. The Minister should have sought another way in which to deal with the more trivial accident cases than through the courts. While I accept that the Minister arranged that the charge may be waived in certain circumstances, it is interesting that the Minister did not stress that, where a claim is not made, there would not be a charge. I presume that would still be the case; that where a claim is not made the health board will not insist on claiming a charge for treating an injury.

Under the last legislation, where there was a trivial injury, say, for instance, a head injury where a person had to be detained overnight for observation and came out the following morning with a bill for say £300, nobody would have told him that he did not have to claim and that in that case they would not have to pay the charge. In that instance people who were worried about how they would pay the £300 would go to a solicitor for advice and a claim would be initiated. That involved a lot of expense to the insurance company which was passed on to those who paid insurance premiums. This put up the cost unnecessarily.

The Minister should have tried to amend this legislation so that insurance companies would give, without admission of liability, a grant to the health boards to pay some of the cost of treating people injured in road accidents who, because of the triviality of the injuries, would not normally take out a claim. What will happen as a result of this legislation is what has happened in the past. People who receive a bill from the health board for hospitalisation will go to a solicitor and litigation will ensue, at great cost all round. The Minister missed an opportunity to negotiate with the insurance companies to try to keep costs down. I accept that the health boards lose over £4 million per annum as a result of the Supreme Court case but another way might have been found to resolve cases rather than the long tedious court procedure.

In relation to injuries, the cost to the State and to the health services and medical profession in time and money should have been looked at by the Minister when drawing up this legislation. This is very important in times of recession and when there is a cutback in manpower. In conjunction with the Minister for Justice the Minister should have considered the court procedure in relation to road accidents and compensation claims. I will not go into whether or not a jury award or a judge award is appropriate. That is a matter for another Department. However, the Minister for Health should try to ensure that expensive consultants do not have to spend days at a time in the High Court.

I am disappointed that there is nothing in the legislation, or in the Minister's statement, to indicate his concern about the question of litigation and compensation involving the health services and consultants. The involvement of consultants in court cases disrupts the normal administration of the health services. There should be another way of dealing with such cases. It does not make a virtue out of the situation that it has been in operation since 1933. That is a good reason why it should be considered to see if it still serves the interests of the people, or if a more practical or a simpler method can be devised to do justice to the individuals concerned.

Another area which should assume major priority in the Department of Health is the question of the implication of so many accidents for the health services. We are all concerned with the human suffering caused to themselves and their families when individuals are injured or killed in road accidents. In 1984, for example, 465 persons were killed on the roads and 8,210 persons were injured. Of these 8,210, 1,000 suffered permanent disability. The cost of those accidents as estimated by An Foras Forbartha in their report for 1984 is £220 million.

The Minister must interest himself in this whole area of the prevention of accidents. I know other Departments are involved, but he must take a special interest in it because of the impact and implications of these accidents for the health services generally. You have only to look at any hospital at the moment and particularly the orthopaedic hospitals because bone injury is the commonest injury in road accidents. In the orthopaedic hospitals, approximately one third of the beds are taken up by accident victims. Consider the misery for those people, the suffering for their families, the cost to the health services, and the hidden factor in which the Minister for Health should take an interest, that is, the number of people on the waiting list for hip replacement surgery particularly in the orthopaedic units. They are suffering pain and are on the waiting list for well over a year and, when their turn comes, their bed may be taken up by the victim of an accident.

Many of these accidents could be prevented. One difficulty we have in legislation where a number of Departments are involved is that very often the legislation gets lost between the various Departments of State. Because of the responsibility on the Minister for Health to ensure the best public health service for the people, he should initiate a programme of prevention of all accidents. This legislation deals exclusively with road accidents and, for that reason, we are confining ourselves to road accidents, but the Minister should initiate a programme to try to ensure that we will prevent as many of these accidents as possible. He should initiate a comprehensive prevention plan involving all the Departments that should be involved.

The Department of Education would have a major role to play here in that they cannot start too soon to teach young children about the dangers, the road code and how to avoid accidents. The Department of the Environment have a major role to play and they have introduced some very good legislation, for example, the seat belt legislation. There is no doubt that that has saved numerous lives and prevented serious injury in many cases. It is encouraging to find that 70 per cent of the people have been wearing their seat belts over the past few years, but still we are not near the 90 per cent who wear seat belts in other European countries. The Department of Justice have a major role to play in implementing the laws and, as I have said, the number of persons wearing seat belts has increased. The drunken driving legislation has been good, but it is disappointing that we are still allowing persons to drive cars with alcohol levels in excess of those in any other European country. As long as we have the number of accidents we have and the number of persons injured, we must take the necessary measures to ensure that we will reduce accidents to the very lowest level possible.

The loss to the Department of Social Welfare in terms of the social insurance fund through disability benefit for persons injured in road accidents is another area that the Minister should be concerned about, as the same Minister has responsibility for Health and Social Welfare. I am sure he is concerned about it but, if we could cut down on the number of persons who lose work as a result of injury, we would be making a major contribution to the people by preventing the accidents and also a major contribution to the social insurance fund by saving unnecessary drawings from it.

I would like to have seen this legislation embodying a legislative package including a number of areas where we could deal with the very serious problems that we have with 465 persons killed and 8,210 injured in 1984. I am disappointed that the legislation is not more comprehensive and that a greater effort was not made to see if some solution could be found other than a very cumbersome method whereby the injured party must go to court to face long drawn out proceedings. In his opening address the Minister of State recognised that the health board charge will not become due until the case is settled, which may take years and longer again if the treatment takes longer than that.

On that point I ask the Minister if that means that a person who is awarded compensation must pay unforeseen health charges arising out of unforeseen complications of the accident. The Minister said that charges shall accrue on the date on which damages are paid or on the date on which the services are provided, whichever is the later. If somebody is injured in an accident, the claim is settled in three years' time and the person is awarded compensation, and in five years' time he has to get treatment for some unforeseen complication of the accident, will he be obliged to pay for that out of the compensation?

I should like to ask the Minister another question. He stated in his press release on 2 July 1985 that the effect of the proposed legislation would be to restore the position which obtained prior to the Supreme Court judgment. Is that the case? Is the position restored to that which obtained prior to the Supreme Court judgment? In other words, are voluntary hospitals affected by this legislation and, if so, how? The legislation refers specifically to health boards. In the Cooke case which was responsible for this legislation coming before the House, the damages were divided. Some of them would be hospital expenses and others would be consultants. Under the legislation will there be a charge for hospitals and consultants or just for hospitals? While we are not opposing the Bill, we are disappointed that the Minister did not avail of the opportunity to take a radical look at what is necessary in 1985. He should not have come into the House and given us the impression that the charges proposed were correct because the system has operated since 1933.

Mr. Carey

The Bill was introduced to take account of a decision of the Supreme Court which arose following a challenge by insurance companies. It is worth recalling that in the debate on the relevant health service regulations in 1971 the then Minister, the late Erskine Childers, when asked about road traffic accidents, felt he had power in section 72 to permit health boards to charge as proposed in the Bill before us. The problem arose because insurance companies took advantage of a loophole in the law. They welched on the people who paid them premiums. Those who pay premiums to insurance companies should be able to rely upon them when they are faced with difficulties. Insurance companies got away from their responsibilities and exploited the law. They are engaged in a bizarre practice of preying on the taxpayer. I do not understand why they abuse the taxpayer and the person who pays the premium. In this instance they sought to renege on their responsibilities.

The legislation before us is timely and insurance companies now have an opportunity to negotiate. In my view insurance companies contribute to the delays; if they think they will get away with something they keep at it for as long as possible. For many years we have witnessed abuse of those paying the premiums and taxpayers who pay for institutions like health boards and hospitals. Before the decision of the Supreme Court was announced health boards did not know where they stood in regard to road traffic accidents. Irrespective of what Deputy O'Hanlon has said, the system being introduced has stood the test of time since 1933, although it may have operated on a slow, lazy and uncontrolled basis on occasions. Other professions, such as the legal profession, take advantage of long delays and they are there to take advantage of road traffic accidents.

The Minister's problem was in regard to charges. He has now signalled that it is the intention of the State to levy negligent drivers for the cost of road traffic accidents. The Minister has told us that it is currently estimated that the charges to be levied could provide income of up to £4 million per year. That money should be used to improve facilities in our hospitals. We all accept that the quality of service for those in need of orthopaedic treatment has improved enormously in recent years. The orthopaedic hospital at Croom has three excellent orthopaedic surgeons and the success rate there is very high, although accommodation is limited. The Mid-Western Health Board, who have had a shortfall in finance, have improved conditions at that hospital and it is hoped that by the middle of next year they will have a second theatre in use. A lot of people in my area with arthritic complaints must suffer because of the 30 per cent planned admission rate.

An Leas-Cheann Comhairle

I appreciate the problems in Croom hospital as much as the Deputy, but I would prefer if he would return to the provisions of the Bill before the House.

Mr. Carey

If the planned admission rate is limited to 30 per cent, therefore the other 70 per cent must be for road traffic accidents. I do not see why those who subscribe to the Mid-Western Health Board area either as taxpayers or through health board levies should suffer because insurance companies want to take advantage of a weakness in the law. Those companies have been paid a premium by their policy holders but they want to continue welching on their responsibilities. I mentioned Croom hospital because the threatre capacity is limited there. Had the Mid-Western Health Board been receiving £500,000 in charges prior to the Supreme Court case conditions there would have been improved and bed numbers increased. We must remember that we are here to improve the quality of the service. I have great admiration for those who work in Croom hospital and I am pleased to be able to report that, although all concerned work under terrible conditions, the success rate has been very high.

An Leas-Cheann Comhairle

The Deputy has been very successful in regard to Croom hospital but he should return to the terms of the Bill before us.

Mr. Carey

I was endeavouring to highlight the problems that have arisen in the mid-west region arising out of the Supreme Court decision in 1983. The Leas-Cheann Comhairle has heard officials complain about the lack of power in regard to road traffic accidents — and that they are not in a position to plan for the future. I have great admiration for the Minister who has introduced this measure. Deputy O'Hanlon put forward some laudable proposals to improve on the provisions but in my view the Minister acted properly in bringing in a short Bill to deal with this problem. I could say a lot more about insurance companies and road traffic accidents, but the Chair might rule that I was acting ultra vires. I commend the Minister on his alacrity in bringing this legislation before the House.

Dr. Ormonde

I am intrigued at Deputy Carey's remark about the alacrity of the Minister in bringing in this Bill. I am very glad that the Bill is finally before us because in a press release on 2 July the Minister promised it to us and we are only getting it on 3 December. We are all aware that the health boards have been awaiting this Bill anxiously for well over nine months in the hope that it would go some way towards correcting the underfunding being experienced by them, due to the failure of the Minister for Health and for the Minister for Finance to provide sufficient funds to run the services. What will happen to these health boards which have now an overrun on their finances?

An Leas-Cheann Comhairle

That has nothing to do with this Bill, Deputy.

Dr. Ormonde

It does concern the financing of the health boards. The Minister invoked section 31 of the Health Act, which means that these health boards will not be in a position to honour the cheques being paid——

An Leas-Cheann Comhairle

That has nothing to do with the Bill. Please come back to that.

Dr. Ormonde

——to their employees for the month of December. I take your point, a Leas-Cheann Comhairle, but that is an issue which should be considered.

Mr. Donnellan

This is an all-embracing debate.

Dr. Ormonde

I shall come back to the Bill in deference to the Chair. As a result of the Supreme Court decision of Walsh v. Cooke in December 1983, health boards have since then not been in a position to charge for inpatient and out-patient services in respect of certain injuries caused by mechanically propelled vehicles. As a result these boards have found themselves in a serious situation because of the loss of additional revenue. This amounts to quite a sizeable sum. The Minister of State earlier referred to a sum in the region of £4 million per year. In the South Eastern Health Board a loss has been experienced in the region of £200,000 in 1984 and the projected loss for 1985 will be in excess of that figure. This is a very significant sum when one considers the present under funding of the health boards.

The Midland Health Board will have suffered the loss of something in excess of £150,000 each year for the past two years and the other health boards have experienced comparable losses over that time. Everybody on this side of the House considered that this was a very urgent Bill and should have got priority over a number of the issues that have been presented. When I see the nonsense that has gone on on occasions, when Bills of this nature are being postponed, I wonder what role this House has to play in the day to day running of the country. The Bill deals with the issue of charges and their recovery only. It entitles health boards to charge for inpatient and out-patient services in respect of certain injuries caused by mechanically propelled vehicles.

It is obvious that we on this side of the House will not oppose this measure. However, I do feel, like Deputy O'Hanlon, that a great opportunity was missed by the Minister and his Department in dealing with this issue. The whole situation of road traffic accidents and insurance claims could have been rationalised here to the benefit of the health boards, the insured and the insurance companies. The definition of inpatient and outpatient services is that assigned to them by sections 51 and 56 of the Health Act of 1970. This means that the cost of vocational assessment and training is neither chargeable nor recoverable. It can be argued that a person injured in a road traffic accident here has an incentive not to avail fully of rehabilitation services, which we all agree are among the best in the world. The greater the recovery from an accident, the less the injured party will receive by way of compensation. There is an argument, therefore, for deferring calculations of compensation until the injured party has availed himself or herself fully of whatever rehabilitation programme has been recommended following medical and vocational assessment.

It would be of financial benefit to motor insurers to fund a rehabilitation programme in the case of road traffic accidents. A health board may charge in respect of services which are being, have been, or will be provided. The trouble with the latter is that they can only be estimated. Will the recipient be required to pass to his health board whatever moneys he is awarded to cover the services that he will require in the future to treat his injuries? This is a matter which has not been clarified in the Bill. If that is to be the case, what will become of this money if the anticipated need does not materialise or, God forbid, the individual dies without being able to avail of the services to the value of the compensation awarded? Will the health board be entitled to be heard in court and involved in out of court settlements? If not, what redress will be open to them where a claimant has understated his or her claim with regard to medical expenses?

The Bill provides only that a health board can make a charge. In the case of patients being treated in public voluntary hospitals, will these hospitals be obliged to notify, and supply the necessary information to, health boards to facilitate the making of a charge? Public voluntary hospitals are not referred to in the Bill, which is a glaring omission. Will a claim fall to be made by the health board in whose area the patient is being treated, or that in whose area the patient normally resides? There is confusion on this. Will the income received by health boards in respect of patients treated in public voluntary hospitals be retained by the health boards or collected by them on behalf of the hospitals concerned? I do not know. Will consultants be entitled to charge a patient whose income at the time of receiving the injury did not leave him or her liable to pay consultants' fees for ordinary hospital treatment? There is no reference to that in the Bill. Is it intended that these charges will be included in the health boards' claims and paid by the health boards to the consultants?

An alternative and more administratively convenient method of financing medical and vocational rehabilitation costs in respect of road traffic accidents would be to require motor insurers to pay a percentage of their premium income to the health boards. The percentage figure could be determined periodically by the Government. The advantage to insurers would be that they would no longer have to reserve funds to make provision for future claims under this heading, by having available to them a known fixed provision. The insurance principle of spreading the cost and risk would be adhered to also in this matter.

Mrs. A. Doyle

While the Bill before us today is purely to allow the health boards to levy charges for admissions due to road traffic accidents, it is salutary perhaps to dwell on the present situation with relation to the health boards, if only with a passing reference. We are now at a stage where there are 162 admissions per thousand head of the population. That has increased over the years from 106 to 125, to 162 in the last ten years. Despite ever-increasing amounts being spent on our medical services we are not improving the rate of admissions to our hospitals generally. The percentage of these statistics that deals particularly with road traffic accidents is not really at issue. What is at issue is that, despite huge, increasing demands by the health boards, demands which have to be met by the taxpayer and the Government, we are not seeing any returns in terms of a better service. Where the blame should be laid, what questions should be asked or who should answer them, we cannot go into today. I appreciate that fully. But we must keep that paramount in any discussion. We must ask, do we need eight health boards? Could the health boards become districts as in England and could one health board run the whole lot? These are questions that will have to be answered on another occasion. But we must bear them in mind in any Second Stage debate in relation to the health boards generally.

The Minister outlined clearly and briefly the exact contents of the Bill before us. The pertinent point is that the Exchequer should not be called upon to bear the costs of negligent drivers. The Minister also underlines that no hardship will be caused by the implementation of this amending Bill. We can rest assured that this will be the case because all our health boards have always exercised sufficient discretion in trying to extract moneys for services rendered. Indeed perhaps they have not been sufficiently successful in this regard in various ways because they have borne in mind hardship or potential hardship in certain cases.

When talking about road traffic accidents the critical position of non-consultant hospital doctors comes to mind particularly. I might refer to the South Eastern Health Board which, by virtue of the fact that I come from that area, I know a little more about than other areas. We all know the general story of casualties when people are admitted to hospitals, the difficulty that is experienced, how this particular group of doctors are expected to work long hours and, in their opinion, are not adequately remunerated for the work they do. Certainly if one is to draw a comparison between them and other medical people in the health boards, they have a case. But more particularly, what can we do to increase the numbers to look after admissions from road traffic accidents and others who come into our hospitals? This is an area that perhaps we should address immediately — I do not know how long this can wait — because no matter what a health board can levy on charges for treating road traffic accident cases, if they have not the manpower and the back up staff to treat these cases adequately, they are not really fit to charge for the service. I might expand somewhat on that particular point. In the South Eastern Health Board area we have the lowest ratio of non-consultant hospital doctors. That is appalling when one considers that we have the highest dependency ratio of any health board, the dependency categories comprising those aged under 14 and over 65, the two groups who demand most of our health services and health care generally.

An Leas-Cheann Comhairle

A passing reference is in order but the Deputy should not develop the point.

Mrs. A. Doyle

These groups are also involved in road traffic accidents——

An Leas-Cheann Comhairle

Would the Deputy please revert to the Bill?

Mrs. A. Doyle

Certainly. With the highest dependency ratio and the lowest ratio of non-consultant hospital doctors in the country relative to our consultants, what sort of service is the South Eastern Health Board fit to give these accident cases? We may well charge for them, and rightly so, particularly those who can afford to pay. But I ask: what sort of service will these people get? We must address this question immediately as it is one of urgent importance in many areas, particularly in the South Eastern Health Board area where little account is taken of the population structure when we talk about charges generally for the health board and their services. Indeed, when one considers allocations given we must be reasonable and remember that, whereas the real rates of payment to the health boards have decreased over the last few years, the actual moneys they receive have increased. That fact is usually lost in discussing health board charges.

An Leas-Cheann Comhairle

Perhaps the Deputy would remain with the Bill.

Mrs. A. Doyle

Please believe me, a Leas-Cheann Comhairle, I am back to the Bill. Nobody in the House could but accept the Bill before us today. The Minister has closed a loophole brought to light during the Supreme Court case in late 1983 in the Cooke versus Walsh litigation. The question of actually levying charges against any accident case cannot be doubted or debated at all. The whole question of the health boards, their handling of it, the number of radiologists, the number of orthopaedic consultants in the various hospitals, the staffing of our out-patients and casualty departments all come within this area of road traffic accidents. I do think passing reference is indeed in order. When we are talking about charging people for a service we should be sure we are in a position to give that service to the people when they reach our hospitals. It is in that context that I am making passing references to some of the facts and statistics that face us today on this issue.

Certainly since the last full year in which the South Eastern Health Board were in a position to levy charges for road traffic accidents, we will now be in the position that in the next full year — which would be 1986 — £200,000 should become available to the South Eastern Health Board as a result of the provisions of this Bill. This would compare with approximately £153,000 which was gathered by the health board in 1983 prior to the legislation. That £200,000 in itself could constitute a tremendous input to the services of all casualty patients, particularly road traffic accident cases.

The south east, having almost the lowest number of consultants per 100,000 of the population, also has the lowest ratio of non-consultant hospital doctors in the country to the number of consultants. Therefore, with the highest dependency ratio in the country, the South Eastern Health Board deserve particular attention in this regard.

Appreciating the Minister's need to maintain strict control in the public sector and on pay in the public sector, I would urge him to find a formula whereby proportionately the population can be treated equally in relation to the capital allocations to the health boards, that those health boards with a high dependency ratio will get their fair share——

An Leas-Cheann Comhairle

That has nothing whatever to do with the Bill.

Mrs. A. Doyle

——and those with the lowest dependency ratio will likewise have their allocations reduced. I have great pleasure in supporting the Bill.

Proinsias De Rossa

I shall be brief and I hope, to the point. I do not support this Bill for the simple reason that I consider it anomalous to introduce a situation in which a person, because they have been injured in a car accident, is then billed for a service which, had they entered hospital because they were suffering from pneumonia, appendicitis or any other ailment, they would have received free of charge. Except in certain circumstances, when people are obliged to pay for consultants, anaesthetists and so on, they are entitled to enter public hospitals free of charge and to receive care there.

This Bill re-establishes the position that obtained up to two years ago when people entering hospital as a result of car accidents, were obliged to pay for the care and service they received. It is my belief that we should not attempt to differentiate between one person and another entering hospital simply on the basis of the type of illness from which they are suffering. In fact we should be moving in the opposite direction. We should be extending the availability and range of hospital services free to our citizens. It is quite conceivable that the Minister could have made up the shortfall which arose because of the court case of two years ago by levying a fee on the motor manufacturers or motor sales organisations, such as Fords, Toyota and others who manufacture cars and sell them to the Irish public. As was suggested by Deputy Ormonde, they could have imposed a fixed levy on insurance companies. I do not consider the making of a particular regulation concerning people who enter hospital as being a correct or adequate response to the costs arising from road traffic accidents. That is not to say that the cost of road traffic accidents in terms of hospital care and other services is not too high. Steps must be taken to reduce these costs. An improvement in the condition of our roads would have a significant effect on the number of accidents.

Mr. Taylor

What about the condition of drivers?

Proinsias De Rossa

I was about to refer to the fact that the condition in which we allow many people to drive cars is a disgrace. The laws concerning drunken driving are not enforced strictly enough. The proficiency of some drivers also leaves a lot to be desired. It is totally insufficient and unsatisfactory to have a test for persons aged 17 or 18 in order to determine whether they should receive a licence while they are never obliged afterwards to do another test.

The introduction of a Bill which will ultimately have the effect of hardening the trend of spiralling insurance costs is not a solution to the problem which the Minister faces in funding the health services. The people who are to be asked to pay as a result of traffic accidents are those least culpable in the misfortune which they have met. It is clearly stated in the Bill that, where a person has some liability in the accident and compensation is consequently reduced, he or she will not be required to pay for hospital services. There is a double discrimination against the person who is innocently involved in an accident while walking, cycling or driving. That person will have to bear the full cost of the hospital services provided.

This is the fundamental reason that I oppose this Bill. It is a totally inadequate response to the funding of our health services and to the whole question of traffic accidents and the results of same. It is also totally unfair that people who have no culpability in an accident in which they are involved will be obliged to pay the full cost. In the normal course of events these will be people who have paid their health contributions and will presumably be in a hospital bed beside a person who will have the service free because he or she was not involved in an accident.

I oppose the Bill. It is a mistake and the Minister should have exercised a bit more imagination before introducing it.

Mr. Durkan

I welcome the Bill on the basis that it merely returns to the position that obtained prior to litigation. It gives the health boards an opportunity at least to get cover for their involvement in cases where very considerable claims are made following accidents. It would be only natural to assume that in such cases the health boards and hospitals concerned, having been called upon to provide a very important service, should get some kind of remuneration. For that reason this legislation is progressive. A point I would make is that the victim in an accident case could be confined to hospital for a considerable time and perhaps a greater proportion of the compensation than anticipated in this Bill could be utilised by the hospital service. I wonder if this might lead to an increase in insurance premiums to cover this eventuality. The citizen might get off a little bit lighter on the one hand, but might be penalised on the other hand. In some cases the citizen could be penalised on both counts if he incurred hospital charges in respect of the accident and also had to pay higher insurance premiums.

It can be a little distressing for people involved in an accident to find the attendant problem of a bill hanging over their heads. Very often such people can be the victims of tragic circumstances. This charge could be a considerable problem for people in unfortunate circumstances. It undoubtedly improves the situation for the health boards and returns to what was the status quo.

The Minister stated:

The charge payable is not specified but would normally be the average daily cost per bed day of the hospital concerned. This will vary depending on the hospital involved.

It would be better to have a set fee. This point should have been more firmly nailed down because it enables health boards to reintroduce charges for hospital services and I cannot understand why the charge could not be specified.

The Minister also stated:

The purpose of the Bill now before the House is to enable charges to be made by health boards for hospital inpatient and out-patient services on persons in respect of treatment of injuries received in road traffic accidents when the injury is caused by the negligent use of a mechanically propelled vehicle in a public place....

That could have some interesting connotations at a later stage. I am not legally minded but I know that some of my colleagues will have something to say about it. There could be contention as to whether a vehicle was used in a negligent fashion. One has to presume that only the courts can decide whether the vehicle was used in a negligent fashion. Perhaps it could be determined by the degree of liability accepted on behalf of one or either party by an insurance company. I should like this point clarified by the Minister.

I should like to give a specific instance and ask how this amending legislation would affect it. A person driving his father's car — this happened — was crashed into by a stolen car. The innocent driver was in hospital for more than six months, his car was wrecked and he was off work for almost nine months. He did not receive any compensation. The driver of the stolen car absconded and the insurance on the vehicle did not cover the accident. The insurance on the car driven by the victim did not cover it either and no State, semi-State or other organisation accepted liability in that case. How will this legislation affect this individual having regard to the fact that he was a long time in hospital and suffered considerably as a result of his injuries? To this day he has not received compensation from any quarter. Indeed, this person's case might be exacerbated by this legislation. Obviously claims will be made and the insurance companies should at least assist the health boards.

Mr. Taylor

The most remarkable thing about this Bill has been the delay in producing it which will cost the taxpayer about £10 million. In December 1983, as the Minister pointed out, the Supreme Court, in the case of Cooke v. Walsh, decided among other things that hospital and medical fees incurred by a person in a road accident could not be recovered against the negligent driver who caused the accident because the injured party was entitled to these hospital services free under the Health Acts. Of course "free" is the wrong word to use. Nothing is free whether it is the abolition of rates, car tax, hospital charges or whatever. All these services have to be paid for.

The effect of the Supreme Court decision in 1983 was that these hospital charges were paid for out of public funds, in other words by the taxpayers, rather than by the person obviously responsible, the negligent driver of the motor car which caused the accident. The suggestion that these hospital charges should be paid for by the taxpayer, rather than by the negligent car driver, is just not tenable. There are many thousands of taxpayers who do not own a motor car and clearly there is no reason why they should have to contribute, through their taxes, to provide hospital services which are needed as a result of negligent drivers. There is no reason to expect people who cannot afford cars to pay for expensive hospital services caused by negligent and dangerous driving of motor vehicles.

Some people may think that the amounts involved here are trifling. They are not. I recall raising a question with the Minister for Health on this subject quite a long time ago and I was told, as far as I can remember, that the cost of providing these hospital services up to that time as a result of the Cooke v. Walsh decision was about £5 million. It could well have doubled by now and that is why I asked about the unaccounted for delay in bringing this Bill forward. It is a very short simple Bill running only to four sections on two pages. Surely when economies are sought it should have been possible to have produced the Bill within a week or two after the decision in Cooke v. Walsh and to have had it passed through both Houses as an emergency measure within a couple of weeks after that. If this had been done, there would have been a saving of millions of pounds to the taxpayer. We are entitled to an explanation of the inordinate delay in introducing this measure.

There is another aspect of the Bill which I find strange and which also requires an explanation. The Bill confines itself to providing for charges by the health boards for hospital services for injuries arising out of road traffic accidents only. There are other accidents, also caused by negligence, namely, industrial accidents caused to workers in the course of their employment in factories, warehouses and so on. Many of these accidents unfortunately involved serious injuries to workers and long and expensive hospital and medical treatment. If such an accident is found to be due to the negligence of an employer in failing to provide a safe system of work, the question follows as to whether the hospital costs, which in cases of serious injury could involve, even in a single case, many thousands of pounds, should be borne by taxpayers generally or by the employer whose negligence was responsible for the accident.

The negligent employer should be liable rather than taxpayers generally and their insurers no doubt pitch their premiums at a figure that takes account of this potential liability and are permitted to do so by the National Prices Commission who control these matters. Yet, for some reason which for the life of me I cannot understand, the Bill only allows health boards to recover hospital costs for road accidents. This has the effect of putting industrial accidents into a different category for which I can see no basis. Both categories involve accidents resulting from the negligence of one party against another.

The Bill confines a health boards's right to make a charge for hospital services, either inpatient or outpatient. The health boards are not given liberty in the Bill to make a charge for the services of doctors, registrars, consultants and so on who are employed by the health boards at great public expense. It would seem to be a logical provision to say that, if the hospital boards may charge for hospital services, they should also charge for the medical services provided to persons injured in accidents so that these heavy costs will fall on the parties responsible for the accidents, road or industrial, and not on the taxpayer.

The point has been made that perhaps higher insurance premiums would be involved if that were done but, if one wanted to avoid this, one could say that the taxpayer would pay the full compensation for anybody injured in an accident and have no insurance premiums. Insurance companies pitch their premiums to take account of hospital and medical charges and it is appropriate that they should pick up the tab for the damages awarded to an injured person.

I can foresee some difficulty in the administration of this Bill, particularly with regard to the provisions dealing with contributory negligence. Many cases are settled on the basis of a reduced amount of damages by reason of the contributory negligence of one party but this is not always specified. I can foresee that in many cases there will be difficulty in fixing the proportion of the hospital charges to be paid by an injured party to the health board. In some cases, to contributory negligence, an injured party may obtain only one-half or one-quarter of the damages to which he would otherwise be entitled. In such cases the intent of the Bill, as I read it, is that they would pay only the same proportion of hospital costs. However, the Bill deals with the matter by giving a discretion to the health board to reduce the hospital account in any such case. This should be more in the way of an obligation on the health board, rather than leaving it to the discretion of the board. I ask the Minister to consider some amendment to deal with this on Committee Stage.

Deputy De Rossa said he would oppose the Bill and I must confess I heard him say that with some degree of mystification. I can only conclude he has not followed the purport of the Bill, because to oppose it will have the effect of leaving the liability for these hospital charges with taxpayers generally, many of whom do not own cars, rather than putting the responsibility where it lies, namely, on the person who drove a car in a dangerous or negligent way and caused serious injury to another. If there is any fault to be found with the Bill it is that it does not go far enough.

Within those constraints, I welcome the Bill. As I did at the beginning, I express surprise it has taken two years, at a cost of approximately £5 million per year of taxpayers' money, to bring this measure forward. That requires an explanation.

Mr. W. O'Brien

I welcome the Bill. I agree with the point made by Deputy Taylor with regard to the length of time it took to introduce this measure. I understand quite well the point made by the Deputy regarding the cost which must be met by the citizens. Another speaker mentioned that the existing services were not adequate to meet all the demands made on them. I can talk only of the regional hospital in my area that has to deal with many accident cases. These accidents cause a considerable amount of disruption and confusion, particularly at night time when doctors and nurses have to be called in.

I am very glad we are getting to the point where people will have to account for and pay for their mistakes. All of us make mistakes and this happens to drivers of cars. I agree with the point made by Deputy Taylor that it is unfair to ask taxpayers, many of whom do not own cars, to meet the costs. Very often people have to stay in hospital for a long while after an accident and in many cases the person responsible for the accident could afford to make a contribution towards the costs involved.

I am rather worried that the Bill deals only with mechanically propelled vehicles. What is the position in the case of an assault on a person? If a person who qualifies for free hospitalisation has to spend three or four months in hospital, if he takes an action on his release from hospital and gets a large sum of money, will he or the person responsible for the assault be obliged to pay? I do not think that is provided for in this measure but I should like it to be included. Our health services can use all the money that is available. In my area we were confined to a limited amount of money but there is an improvement at the moment. Nevertheless, we can always use more funds. I welcome the legislation and I hope that the Minister in his reply will clarify the position with regard to cases of assault.

Mr. J. Leonard

The legislation is welcome, but it is long overdue. The health boards were faced with a serious situation following the Cooke v. Walsh case two years ago. I agree with the point made by Deputy Taylor, namely, that this was a minor Bill but one that took a long time to come before the House.

Road accidents have serious implications for all the people involved. In my area we have an orthopaedic hospital that has a long waiting list. Some people have to wait up to five years for hip replacement operations. Those delays are due entirely to the amount of orthopaedic work that must be undertaken as a result of road accidents. The Minister should have taken acount of this burden on hospital services when he was considering this legislation.

Insurance companies have got off fairly lightly in the past few years. Section 2 provides that a health board may charge for hospital services provided for a person injured in a road accident and it also provides that the board may waive the whole or part of a charge under certain circumstances. That is an important consideration because we do not wish that hardship be imposed on any person. The ratepayers should not have to carry the liability for the insurance companies, as has been the case in the past few years. It is essential that the people who benefit from insurance premiums should pay the costs involved. I should have preferred the Minister in drafting this legislation to have looked at the whole situation, with particular regard being taken of the health services, of those maimed in road accidents and of the economic situation. This reduces our budget for hospital services but the reduction is not easy to arrive at. We are examining the geriatric, psychiatric and general hospitals and better community care facilities. Accident cases have been imposing a heavy burden on the health services and this Bill was long overdue.

Mr. Skelly

I had not intended to speak until I heard some of the contributions and the naivety of the points of view expressed. If people believe that these charges will be passed to the insurance companies, they are making a serious mistake. I have no doubt that the insurance companies will not pay, that the hard-pressed, under-privileged and deprived people will be the major victims.

I am amazed at how quickly the establishment, in the name of the insurance companies, can get this House to act when they want something done. It is unbelievable, when one thinks of the battles we have to engage in to get civil liberties and easement for hard-pressed people who are under-privileged, suffering from lack of educational opportunities and careers, how the establishment can come in here and with a wave of a wand within a few weeks can get legislation through the House to ease any pressure on the insurance companies so that they can make more profits.

This is the second time in a short period that this has happened. The other is the promise to remove civil juries, which will mean that again the winners will be the insurance companies. Apparently, the 12 men and women, good and true, cannot be trusted to make awards to people badly injured in car accidents. The awards they are making, only in the eyes of insurance companies, are far too high. The guise in which they suggested such legislation is that it would reduce premiums. Now that the legislation has been promised, the companies say it will not affect premiums, that they will remain the same. We have peers of the establishment, namely judges, who are better trusted to make sure that under-privileged people will not get too much money, perhaps because they might not know how to spend it, or because they are not entitled to it because of the standards of living they have been accustomed to. Therefore, smaller amounts of compensation will suffice in the future.

An Ceann Comhairle

These points are not in order in this debate. References to the jury system are not in order because the scope of the debate is very limited. It is a question of whether health boards can charge for services rendered and maintenance provided for people injured in road traffic accidents. That is the only issue.

Mr. Skelly

That was by way of preamble——

An Ceann Comhairle

I have allowed enough preamble.

Mr. Skelly

The same thing will happen through this measure. I ask the Minister to think very carefully when he introduces this Bill in this form. He should consider the consequences. One of the points I want to make is on the suggestion that hospital charges are too high, that the insurance companies are getting off scot free and that the charges are falling back on the taxpayer. The hospital infrastructure is there. We have basic overheads which will not change regardless of who foots these bills. The buildings and the staff and the beds are there and if they stay unused the charges will still be the same.

Because people are not able to look after themselves through lack of education or other circumstances, they are given awards but they are not fit to judge whether the awards truly compensate them. When hospital charges are deducted from such awards they eat into the compensation and people are likely to end up with very little and may have to carry bad injuries for the rest of their lives. Perhaps their lives are shortened or they may not be able to work but will not have enough money left to enjoy the standards of living they had before the accidents.

A person may have been on disability benefit before the accident. Then an award is made, and the disability benefit paid in the interval between the accident and the payment of compensation is removed totally because of the award. Such unfortunate people are told that when they use up the compensation, which does not take very long, and they are impoverished again, they can reapply for disability benefit. They are told: "We will allow you to keep the money you were awarded, which was to do you for the rest of your life because of disability caused by the accident. You must use that money first, and then we will consider giving you disability payments." That is unfair.

Most insurance claims for accidents are sorted out out of court. Settlements are made because people cannot afford to take on the insurance companies. Settlements are made which do not allow, for example, persons to make claims for medical or hospital expenses in the future. The insurance companies offer the money now with the stipulation that they will not pay for future medical or hospital expenses. Does the patient, in such circumstances, have to come up with the money himself? Insurance companies have the power and the means to force people to accept settlements out of court. They can drag the cases out for four or five years, with the help of our system, and people are waiting five, six or seven years for settlements.

What happens in the case of a quadriplegic, a person who is paralysed from the neck down following serious injuries? Such a patient may have to lie on his back for 20 or 30 years. We here decide to remove the jury system because such a person is awarded £200,000. Awards of £200,000 or £250,000 or even £300,000 are based mainly on the need for care and attention because of terrible injuries. I do not know whether it is known here, but the maximum amount payable to a quadriplegic is £100,000, comparatively a tiny amount of money. If the award is greater than that, say, £100,000 or £150,000 more, it will be in the nature of special damages for care and attention. It is an outrage and a scandal that people should complain about the high awards granted to those unfortunate people.

An Ceann Comhairle

The Deputy is moving away from the Bill again.

Mr. Skelly

I do not think so.

An Ceann Comhairle

Unfortunately, I must decide and that is my opinion.

Mr. Skelly

I would refer you to section 3, which relates to recovery of charges by health boards. Subsection (1) provides that any sum due by a person to a health board by way of section 2 may be recovered by the health board from the person by way of a simple contract debt in any court of competent jurisdiction.

An Ceann Comhairle

That does not provide a platform for a general discussion on damages.

Mr. Skelly

May I ask, then, whether we are talking about enabling health boards to make charges in respect of inpatient and outpatient hospital services for people entitled to receive damages or compensation for injuries caused in road traffic accidents?

An Ceann Comhairle

The Deputy has been talking about damages generally. He mentioned a figure of £100,000.

Mr. Skelly

I gave an example. I am very disturbed to hear that I cannot follow this line.

An Ceann Comhairle

I would not wish to disturb the Deputy but I must draw his attention to the fact that he was broadening the scope of the debate.

Mr. Skelly

I am very serious about this. I have had the experience of having a father-in-law who for five years was a quadriplegic as a result of a road accident, so I know what I am talking about. I have undertaken a lot of research in the area of injuries. There is no service anywhere in the country provided free for quadriplegics. I am aware of the suffering of those people and I know from my experience of courts that there is a great lack of understanding in regard to the awards made. Very often those who regard awards granted to road accident victims as being huge do not realise that the award is made up of a special damage award and a general damage award, the general damages being the award for the injury and the special damages being for care and protection.

What we are providing here will rebound on the shoulders of the unfortunate victims. By this legislation we are not letting the taxpayer off the hook in any way. The insurance companies will be well able to adjust their figures in such a way that the victim will be the one disadvantaged. I am trying to save the Minister the embarrassment of having to take court action against these unfortunate victims. Spread over a number of years, the amounts of the awards do not compensate for injuries, because very often these people become very sick as a result of the accidents they have suffered. Deputy O'Hanlon may be able to support me on this when he is contributing to the Committee Stage debate. While a person may suffer only a broken leg, he may become a sick person later because of the accident. Deals are done in most cases in the courts by the insurance companies, but when agreement is reached the accident victim must sign to that effect that he will not qualify for any future payment. That means that, as happens frequently, if the victim must be hospitalised later in life because of the effects of his accident, he cannot claim any more money from the insurance company. What we are providing here is that if in such cases the accident victims have any money left from the award the health boards will be in a position to seek moneys from them. Why should we be doing what is the job of the insurance company? Why should we be providing for the health boards to chase the unfortunate victims for money? I am not sure that the Minister is providing the answer in this Bill.

I understood it to be the intention of the Minister and of the caring parties who make up this Government to provide the best possible service for the people. In the past few days I have heard the suggestion that there should be a free GP care service, with the doctors being paid a salary. This Bill is not in the spirit of any such suggestion. Neither is it a move in the direction to provide free hospital care. A former leader of the Labour Party, Mr. Brendan Corish, put forward the suggestion a long time ago that free hospital care be provided for everyone. What we are doing here is a retrograde step. The only people who will benefit from the provision will be the insurance companies, who do not have to take into consideration the profits they make from their property portfolios or other areas of business in order to seek an increase in car insurance premiums. They can isolate motor insurance and, in the event of that area not showing a profit, they continue increasing the premiums. I am as opposed to this provision to the same extent as I am opposed, and opposed irrefutably, to the removal of juries in civil cases.

In many of these accident cases the people concerned are not clever enough or well off enough to have separate insurance cover that would help them in these sorts of cases. We are somewhat naive in moving in this direction quickly in the belief that what we are doing will help reduce the bill for the health services. For the past ten or 15 years it has been my understanding that our intention was to provide a first class hospital service. It must be said that we have a very good hospital service and also an excellent service from the medical profession. As I have said before, that profession shame the legal profession in terms of the reasonable fees charged compared with the astronomical fees charged by the legal profession. A highly qualified medical person is prepared to attend at a person's home day or night at a very reasonable charge while no service from a solicitor would be provided for less then a few hundred pounds. That profession failed to respond to the invitation issued to them to help us in another area of legislation. The medical profession, too, will be winners in terms of what we are doing now. We are helping this wealthy, privileged and elitist profession to extract huge fees, but at the end of the day the unfortunate accident victim is the one who will be paying.

An Ceann Comhairle

This may be all very interesting but it is not within the scope of the debate on the Bill.

Mr. Skelly

I am sorry if that is the case but I am trying to remain within the ambit of the Bill. I consider that the proposal that the health boards charge accident victims gives rise to the points I am making because the victim will be the one to be at a loss. Compensation will be shared in such a way that both the insurance companies and the lawyers will be paid but the victim will have to pay the medical services that have been provided by all his willing and co-operative fellow citizens in the past decades. He will not be in a position now to avail of his rightful share of those facilities. Those facilities are there for him and he is entitled to them. I do not think we should help the insurance company in this way because they are the people who will avoid this.

I ask the Minister to put sections into this Bill which will guarantee that the insurance company cannot compel a patient to accept an award which will not fully compensate him for his injury. Let the Minister put into this legislation the true rate of compensation and not allow the insurance company to play with the lives of the disadvantaged in our community. What is the state of mind of a person who has been involved in an accident, who has a plate in his head or has had serious operations? How can he defend himself?

We must try to help him. I do not believe he is being protected in this legislation and much more work will have to be done on Committee Stage. I beg the Chair's pardon for raising this matter in this way but, as I always say when short Bills are introduced, it terrifies me to see short Bills going through the House because very often their results can be very damaging. Only last week a two page Bill — £300 million — went through this House and I had the same difficulty in trying to get my point across.

I want to bring this to the Minister's attention because it is of the utmost seriousness. Deputies have welcomed this Bill because they believe it will do a lot of good, especially for the hard pressed hospital boards, but I beg them to think again. Admittedly their intentions may be well meaning but I do not think they have seen the danger, although Deputy De Rossa has and I agree with him. The people this legislation is meant to help will be victimised by it instead.

Why does the establishment always win, and win so easily? The individual may be used as a guinea pig in drug tests and if he meets with an accident he will suffer the indignity of a wrangle about money. If he is a member of a family who are hard pressed, and they have to look after him while he is sick, he can unwittingly be putting extra pressure on his family. The monetary compensation award will be mitigated as a result, and we are helping that process. If the person involved is a child, it is even more tragic because a child does not want to inflict hardship on his or her parents. If the person involved is an adult, he will be humiliated. Has anybody in this House, other than Deputy O'Hanlon, witnessed such cases?

An Ceann Comhairle

The Chair finds it very difficult to follow the Deputy's argument but there is one thing clear, and that is that it is not relevant to this Bill. The scope of the Bill is within the long title and it is very limited. The Deputy may get another opportunity to make this point on another Bill. What he is saying now about the quantum and inadequacy of damages might well be in order on the Bill to abolish juries, but it is certainly not in order on this Bill. I ask the Deputy to fall in line with the ruling of the Chair.

Mr. Skelly

It may be limited in the Bill, but the damage it will do is not.

An Ceann Comhairle

The Deputy will obey the Chair. I am going to take a firm stand on this. He will get another opportunity——

Mr. Skelly

Is the Chair guaranteeing that another Bill is coming before the House——

An Ceann Comhairle

The Chair is not guaranteeing anything. I am pointing out that the contribution he is making in general terms about damages is not in order on this Bill.

Mr. Skelly

Then I will have to quote the Bill.

An Ceann Comhairle

The Deputy will have to obey the Chair.

Mr. Skelly

Is the Chair telling me I cannot debate this Bill?

An Ceann Comhairle

I am telling the Deputy that he must confine his argument to whether a health board may charge for services rendered to a road victim or whether they may waive certain damages.

Mr. Skelly

Can I say why?

An Ceann Comhairle

I will tell the Deputy when he is in order and when he is not.

Mr. Skelly

According to the Explanatory Memorandum the purpose of the Health (Amendment) Bill, 1985, is to enable health boards to make a charge for inpatient or outpatient hospital services on a person who received, or is entitled to receive, damages or compensation for injury caused in a road traffic accident. The example I was giving related to a person involved in a road traffic accident. If the health board are entitled to make a charge for inpatient or outpatient services and as a result that causes hardship on the victim's family, be he a child or an adult, the health board are helping to increase the financial hardship suffered by that family. I submit that that is very relevant. If the person involved is a child, he is an innocent victim but if the person involved is an adult and as a result of his injuries is a quadriplegic, he will be lying in a bed able to move only his head, although he is compos mentis and he will have to suffer the humiliation of being looked after by his family, knowing they will not get adequate compensation. He will suffer immeasurably, mentally as well as physically——

An Ceann Comhairle

The Deputy is speaking about general damages.

Mr. Skelly

I am speaking about a health board making a charge for services. That is what this Bill is all about. I am saying the Minister should include protection to ensure that, in the case of compensation which is usually paid by the insurance companies——

An Ceann Comhairle

If the Deputy thinks so, he may submit amendments on Committee Stage.

Mr. Skelly

This is a Second Stage debate.

An Ceann Comhairle

Precisely.

Mr. Skelly

Surely I am allowed to say something on Second Stage.

An Ceann Comhairle

If the Deputy thinks his amendments are in order, he may submit them on Committee Stage.

Mr. Skelly

I will and I want the Minister also to consider them. I am trying to point out the immeasurable hardship that will result if this point is not cleared up. It is the Minister's good intention that health boards should not put extra pressure or burdens on another taxpayer, because the policy of the health boards and the hospital services is to help as many people as possible. But there is a danger that we are going down the wrong road with this legislation because the people who will come out at the wrong end will be road accident victims, and the charges will come from the compensation paid and that compensation will not necessarily be adequate to cover the person's injuries.

That is my main point. In the case of the compensation not being adequate the victim is pauperised and if he gets disability benefit he will depend on a pittance to survive. He will be humiliated and his dignity will be destroyed. In many cases his standards of living will be destroyed as will that of his wife and family. On that basis this Bill is not properly thought out. It will have the opposite effect to that which is intended. I am highlighting this for the benefit of other Members. If compensation is to be paid it should be a separate payment by those who have to pay the compensation, and not by the victim. It should not be taken out of the award to the individual. There should not be a restriction on future claims. Has the Minister considered this? If it turns out to be impossible to put that stipulation in, hardship will occur and the Bill will not work out as intended.

Under section 3 of the Bill any sum due to a health board by a person is recoverable by the health board from the person as a simple contract debt in any court of competent jurisdiction. Does the Minister really want to be involved in the health boards suing people for payment of compensation? All of us who hold clinics know of people in that situation, except that they cannot be sued. They are constantly begging the Minister and his officials for disability benefits or supplementary benefits because they cannot afford to live. The Minister's Department are asking these people to pay from the compensation they get, and when it is used up they can come back to the Department——

An Ceann Comhairle

That is a Social Welfare matter.

Mr. Skelly

That brings in the social welfare aspects.

An Ceann Comhairle

It does not. It is not in order in this Bill.

Mr. Skelly

Has the Minister considered that? This will put more pressure on people who have injuries or who become sick as a result of injuries. The health boards can now sue them. What happens to the people who pay the compensation? They are free. They are not being sued. I am asking the Minister to take into consideration the state of mind of the person who is suffering injury and paid who will end up in this situation just to save the health boards a few bob. The Minister is doing a fantastic job and has made a lot of progress, but he should look at areas other than this one to effect savings.

Section 3 (2) says:

Without prejudice in Part III of the Statute of Limitations, 1957, a cause of action against a person in respect of a charge under section 2 (1) of this Act shall be deemed to accrue on the date on which damages or compensation are paid by the person liable to pay such damages or compensation or on the date on which the services to which the charge relates are provided, whichever is the later.

It is frequently the case that when a settlement is made it is a full and final settlement which does not allow a victim to make a claim at a future date for medical or other expenses. Perhaps Deputy Andrews would enlighten me from his experience as to the percentage of accident cases settled out of court. I am sure it is a very high proportion. If a person who is half dead agrees to a settlement, he has no comeback. We meet these types of people at our clinics and they have no recourse except to apply for disability benefit or supplementary welfare benefit — they can get no other monetary satisfaction. The Minister is saying that these people will have to pay and under section 3 (2) of the Bill we can sue them. Does the Minister really want to get into that area? There is total imbalance in the Bill. It is the advantaged against the disadvantaged. It is the establishment against the people. What I am trying to do, without annoying the Chair——

An Leas-Cheann Comhairle

You have not done it yet.

Mr. Donnellan

You got the best of his predecessor.

Mr. Skelly

I am trying to put the case for the disadvantaged individual. Over 70 per cent of my constituents are disadvantaged, so I am not unfamiliar with the problems. I am alerting the Minister to this because I know he would not dream of inflicting hardship and that he would amend this legislation if he thought that as a result of this measure hardship would be created for people.

There is another point in relation to car owners. Perhaps the well-heeled car owner is separately insured. People are inclined to take the awards granted at a given date and think of the value one would get if it were spent immediately without bearing in mind that it has often to compensate a victim for the rest of his life, or it may have to provide extra facilities, extra nursing, extra home care and so on. There is tremendous pressure on that victim to spend some of that money. He would not be human if he did not offer to do so by helping out his poor family, because he is not used to having such an enormous amount of money, and that means that he is short changed from the beginning. If a settlement is made and the Minister can sue him on the charge by the health board, then probably he will be in no position to pay. We should not come down heavily on those whom we have been trying to help over the years.

Finally, a sad note to end on. The insurance companies are in business, very big business. They are not worried about minions. When insurance companies are involved in claims, in order to try to mitigate the amount they have to pay they are not above dragging out a claim for as long as possible, and those involved, even on the periphery, often in a case of serious injury, will wait to see if the person will die. That can go on for years. A person might have only a short time, a year or two, to live after a serious accident and the insurance company will, without any qualms, try to drag out that claim beyond that time so that the person will die and, as a result, they will have to pay no or very little compensation. They are the people who will benefit from a Bill such as this. It makes one think very carefully before one would bring in a Bill such as this or would dare to tamper with the civil jury system.

Mr. D. Andrews

That is a very unfair charge against the insurance companies.

Minister of State at the Department of Health (Mr. Donnellan)

I thank all the Deputies who contributed to this debate — Deputy O'Hanlon, Deputy Carey for his complimentary remarks, Deputies, Ormonde, Avril Doyle, De Rossa, Durkan, Taylor, O'Brien, Leonard and, last but by no means least, Deputy Skelly, who indicated that he may try to amend the Bill on Committee Stage. He is quite welcome to make an attempt anyway. Perhaps, if he puts down amendments in relation to compensation, on which he made very strong points, the Minister may find some way to accommodate them, although I must point out that they have nothing to do with this legislation.

All others supported the Bill wholeheartedly, with an odd reservation here and there, except Deputy De Rossa, who opposed it totally. As a man who represents The Workers' Party, I cannot understand his stance. This Bill is putting the responsiblility back on insurance companies to pay for the medication and so forth of people involved in road traffic accidents on the responsibility of the driver of the mechanically propelled vehicle. If it is left as it has been for the last two years, it is the responsibility of all the people and I presume that The Workers' Party, by virtue of their name and the category of people from whom they look for support, would be less inclined to own MPVs than other sections of the community. Therefore, if they are opposing this Bill they are saying that they want the community at large to pick up the bill.

I refer to a couple of points in my opening speech. The Exchequer should not be called upon to bear the cost of the results of negligent driving. Insurance companies have been paid premiums to underwrite these risks and up to two years ago they were reponsible. For the past two years, since 16 December 1983, they have not been responsible; but as a result of that we saw no drop in insurance premiums. The companies call for this, that, and the other; and, because of the no claim bonus, if you have a claim they will up the premium. Surely the Deputy will change his mind in view of what I have quoted to him. Basically he wants to put more taxation on the people he purports to represent.

We believe that this measure will save the State something in the region of £4 million per year. A point made by a number of Deputies here was that it will mean extra cash for all the health boards. I am sure they can use it. This is the first time they can say that because of legislation by this administration extra cash will come into their hand, and they should welcome that.

People talked about the large number of accidents. They thought that the Department of Health should be involved in trying to prevent these accidents. We will co-operate with any other Department, but this really refers to the Department of the Environment and possibly the Department of Justice. We regret that there are so many accidents. If we in the Department of Health can help in any way to ensure that fewer accidents occur, we will certainly do so. Other people complained about the condition in which drivers are allowed to drive. I presume that means the alcoholic condition. Certain laws govern that and it is not the responsibility of the Department of Health to operate these laws. As far as I am aware, they are operated quite effectively by the Department responsible for their operation. If people think that drivers are allowed too much alcohol in their blood at the moment, then Private Members' Time or other opportunities in this House may be availed of to bring in a Private Members' Bill to remedy that.

Other people talked about the loss of life. I more than anybody else regret the loss of life. Deputies O'Hanlon and Ormonde talked about the voluntary hospitals and how the charges work in relation to them. Voluntary hospitals provide services on behalf of the health boards under an arrangement entered into under section 26 of the Health Act, 1970. We have been advised that the power to raise charges should rest with the health boards, who can also recover sums due under section 3 of this Bill. In practice, where the treatment has been received in a voluntary hospital, the bills will be issued by the voluntary hospital on behalf of the health board.

A number of points were raised — I do not know whether I should refer to them — about the amount of awards. Deputy Skelly in particular referred to the amount of awards in accident cases. We have nothing whatever to do with what the courts do. The Department of Health have no input into that. If there are certain charges the health board can look at the circumstances of the individual in question and impose charges or part of a charge. If there is not an award there will not be any charge. There will not be any charge by a health board until such time as a decision has been announced. Deputy Skelly and others asked about people who may suffer an injury which may necessitate treatment a number of years later. I should like to tell those Deputies that health boards will look at all circumstances in such cases and will take into account the fact that an award may or may not have been made and the circumstances of the individual.

Mr. Skelly

Does the Minister want to put a person up against bureaucracy trying to square it off for years begging his or her case?

Mr. Donnellan

We are trying to regulate the matter in the best way possible. Deputy Ormonde and others alleged that it took the Government a long time to bring in the Bill but I must point out to them that we had to be sure of its constitutionality. I should like to remind them also that the Bill was introduced in the House on 27 June 1985 but when the Minister for Health sought permission to deal with all Stages on that date he was refused. It is not his fault that the matter was not dealt with sooner.

I should like to thank those who have contributed to the debate and to point out that on Committee Stage we will be only too anxious to listen to what the Opposition have to say.

Dr. O'Hanlon

Will the Minister tell the House if this will bring the situation back to what existed before?

Mr. Donnellan

Largely to what existed before in practical terms.

Dr. O'Hanlon

That is not enough because there may be terms that are not the same and we want to know them.

Mr. Donnellan

In practical terms it brings it back to the position that existed prior to 1983. We belive that the measure is constitutional.

Dr. O'Hanlon

Will the consultants have the right to charge as they would privately?

Mr. Donnellan

I presume they will.

Question put and declared carried.

An Leas-Cheann Comhairle

When is it proposed to take Committee Stage?

Mr. Donnellan

On Tuesday next, subject to agreement between the Whips.

Committee Stage ordered for Tuesday, 10 December 1985.