No, between them. That is the calculation I made to the best of my ability. I have taken them all together and put particular emphasis on the Eastern Health Board and have looked at the others and the difference between their budgets and what has been allocated to them. I believe that the eight regional health boards between them would require an extra £8 million this year to provide adequate health services at the same level as existed during 1975.
I believe that another £7 million to £8 million would be required for the voluntary hospitals and the general medical services payments board. This means that in the region of £15 million would be required in the Estimate for the Department of Health to enable our health services to get through this year without serious disruption. It is very difficult for someone who has not access to the official figures, information and statistics to try to quantify the situation. The best estimate I can make of it is that between the health boards, the voluntary hospitals and the general medical services payments board somewhere in the region of £15 million would make the situation reasonably satisfactory. I suggest that the Minister should try to get it across to the Government, where the ultimate decision in these matters lies, that that additional money must be provided by the Exchequer. I also want to make it clear that it is not my responsibility to propose how those funds should be provided as I have not the details of budgetary policy and the different demands and pressures which would enable me to decide where that £15 million is to come from. That is the responsibility of the Government.
I want to make it clear that I am not demanding any new services. This Government, and particularly the Taoiseach and the Minister for Finance, continually resort to the argument in relation to the Opposition of saying that if we demand some new service, some new facility or some additional improvement we must state where the money is to come from. I do not think that is a valid argument but it is one the Government use ad nauseam. I am not asking for any new service so that argument does not apply in relation to what I am saying. I am only asking that the existing services, which were there throughout 1975, which were built up to a certain level over the years and were maintained at a certain level during 1975, be maintained. I am only asking that an additional amount of money be provided by the Exchequer to enable those services to be maintained throughout 1976 at that level.
I believe these additional allocations must be made. It is my duty in Opposition to point that out to the Minister, the House and the general public. At this stage of 1976 unless those funds are provided our health services cannot be maintained at an acceptable level during this year. It is not for me to say if that would involve a rearrangement of existing budgetary provisions or whether it would involve some other measures. I believe this could be done within the confines of existing budgetary provisions. I admit I have not the information to assert that positively or definitively. Whatever else has to be sacrificed, whatever other economies must be made, hospitalisation of the sick, medical care and attention for those in need are basic requirements in any civilised community and any rearrangement of the budgetary provisions that have to be made to enable those essentials to be provided must be and should be made now.
I want to make it clear that I am not purporting to the House to have the knowledge which would enable me to make any positive assertion about this matter but I want to put it before the Minister. Perhaps a review should be made of the structure of the regional health boards. I hope I am not one of those people who just look at any organisation and say that it is top heavy, unwieldy and bureaucratic. I believe the regional health boards have done a good job in developing services, in exploring needs and in endeavouring to provide new programmes to meet needs but whether or not there is excessive cost in the bureaucracy of the health boards is, perhaps, something that might be examined at this stage. I believe it is an area which would merit examination in the context of the rearrangement of financial provisions which I am suggesting to the Minister.
I cannot escape, in that connection, a conclusion that there is a good deal of covering up going on between the health boards and the Department of Health over the budgets for 1976. As I pointed out during the discussion on the Private Members' motion recently the allocations made by the Department of Health fell far short of the budgets prepared by the health boards and submitted by them. The shortfalls range from £300,000 approximately in one case up to £3.7 million in the case of the Eastern Health Board. The chief executive officers of the different boards, as was their duty, submitted reports to their respective boards indicating the extent of the shortfalls and outlining proposals for cutbacks and reductions which the allocations would force them to adopt. That process took place from January through February in the case of all the boards. The chief executive officer and his management team pointed out to each board what the deficit was and how he thought it could be met. Those proposals which were put forward by the chief executive officers varied in content and severity from board to board but they all followed the same general pattern. Their decisions were to restrict the issue of medical cards, restrict visiting and prescribing by doctors for patients on the general medical service register, cut down or eliminate the transport service for patients to hospitals and other centres, cut back community services like meals on wheels, home help, free milk, dental services and so on; cut down on repairs and maintenance, on heating in homes and hospitals and reduce different benefits under their control; cut down on the child medical examination service in the schools.
All of these and many other proposals were made by different executive teams to different boards throughout the country. One of the most drastic proposals in this regard was put forward by the Eastern Health Board in regard to St. Loman's Hospital. There, the suggestions put forward by the executives and the programme managers bordered on the ridiculous. There were proposals such as removing corn flakes from the breakfast menu, making desserts simpler, cutting down on minerals and soft drinks, cutting out newspapers for patients and stopping taking patients to cinemas. Various other almost ridiculous economies of that sort were proposed for the unfortunate inmates of St. Loman's Hospital, people who could not fight for their own rights in this matter. The Minister has since tried to deny that the Eastern Health Board actually proposed these reductions, cutbacks and economies but they were seriously put forward in St. Loman's by the management and probably they are still in operation.
Throughout the country in the different areas of responsibility of the boards all sorts of economies, cut-backs and reductions were put forward. Subsequently, discussions were held between the managements of the different boards and teams from the Department of Health and, arising out of these discussions, we were led to believe that the deficits had been eliminated and that the boards would be able to manage within the allocations that had been made. I find that very suspicious. So far as I am concerned it is all very dubious. Were the budgets, as originally submitted, not genuine? Were they not prepared on a prudent, economic basis? Were the executives in the health boards guilty of irresponsible, careless budgeting and financing? If the team of officials from the Department of Health could come along and revise the budgets so that the deficits disappeared, surely something was wrong in the first instance?
In fact, I do not believe that the executives and the management teams submitted inflated, irresponsible budgets in the first instance which were subsequently pared down by the team of experts from the Department of Health so that the deficits could disappear. I do not think that happened. I think the deficits are still there in reality. They have been eliminated on paper and I think this is particularly so in the case of the Eastern Health Board. There is a great deal of bluff and covering up going on in regard to this matter. The real deficits are still there and they will manifest themselves as the year goes on. These cut-backs and deductions will take place. It is all just a propaganda exercise resulting I am afraid from collusion between the Department of Health and the executives of the health boards. So far as I am concerned at this stage until I am satisfied otherwise there is a great big question mark hanging over this situation.
It is a very serious situation. All those concerned should know that the regional health boards structure has its very determined critics throughout the country, people who have never accepted the concept and who believe it is not the best solution to our health administration problems. If it is going to be demonstrated that a big deceptive exercise has been engaged in throughout the health boards with the Department of Health, those critics of the health board structure will be greatly strengthened in their opinions and in their doubts about the value of the whole regional health boards structure.
The situation that has arisen, that of a very inadequate allocation having been made in the budget for health services this year, is a reality. I have tried to quantify the overall shortfall as somewhere in the region of £15 million. I may be wrong about that but there is no doubt that there is a serious shortfall in the provision made by the Government. However, it has this possible side advantage, namely, that it serves to focus the attention of all of us on the question of the future development of our health services and their financing.
The Minister made a very passing reference to that in his speech when he referred to the fact that the present system for financing health and social welfare services is being reviewed by an inter-departmental committee of representatives of the Departments of Health and Social Welfare. That is very interesting. There is an inter-departmental committee of the Departments of Health and Social Welfare dealing with the finances of the health services but there are no representatives from the Department of Finance. Surely this is an absurdity. How can there be any inter-departmental investigation into the financing of the health services without someone from the Department of Finance being present? Is this a political gimmick? Is it just because health and social welfare are under the same Minister? Of course he has a Labour Parliamentary Secretary in charge of social welfare. Is this a nice, friendly, Labour exercise? In any event, I do not believe that an inter-departmental committee is the appropriate machinery in this instance. Certainly an inter-departmental committee that does not include a representative from the Department of Finance is meaningless.
This serious situation in regard to the health services and their financing must dictate to us that we should look at the health services as a whole in total, their future development, the extent to which they are being developed and how that development will be financed. We must ask ourselves whether it is possible to provide for the development of our health services on a planned, orderly basis and to have that development financed in a way that would make those services either totally immune from budgetary crises from time to time or else put them in a situation where they would be only marginally affected. That is the key question we must face up to. Can we so devise the financing of our health services that if there is a budgetary crisis which involves the settling of a particular budgetary policy for economic or financial reasons that that budgetary crisis will leave the health services comparatively untouched? Must we go on with the situation where a budgetary crisis, brought about by economic or financial causes and with nothing to do with health, causes this serious dislocation of the health services?
In that context I suggest that we must maintain a sense of proportion here. We must realise that we are not now having to deal with a situation, as some people suggest we are, where the cost of our health services has escalated to an unmanageable level in relation to national economic resources. It is important that we realise that. Of course, we have the problem of providing the necessary finance for our health services but I do not think we should panic or that we should accept the argument some people put forward that it has got out of all control and has become unmanageable and can no longer be rationally related to the resources which we can provide. I calculated that not more than £15 million extra would be needed this year to maintain all our existing services at a reasonably satisfactory level throughout the year. In absolute terms that is a large sum but it is not a figure of intolerable magnitude in relation to an overall expenditure in this year's budget of £1¾ billion which is the total of our non-capital budgetary expenditure in 1976. When one looks at the extra amount I am suggesting as being necessary to provide adequate health services this year it is not all that absurd in relation to that overall figure.
I do not think we need to be totally intimidated in this House or in the inter-departmental committee by the level of our health expenditure in relation to our GNP or our total budget at this stage. We have not yet got into an uncontrollable nightmare situation as they have in other countries. I believe that a comprehensive set of decisions are necessary at this stage on the shape of things to come if we are not going to run the danger of getting into that sort of nightmare uncontrollable situation. We must decide the fundamental issues about the sort of health service we are going to have and the rate at which we are going to progress towards that health service.
A health service for this country must be designed for our own needs. It must be suited to our own circumstances and be directly related to our economic and financial capacity. It is on those grounds that I have on occasions attacked the Minister. In my view I was justified in doing so. I believe that the Minister is inclined to import ideas here; he is more inclined to look at some outside system which he admires and to transplant it in its entirety into our circumstances. I do not think that will work and that is where we have to have good sound basic thinking in regard to the whole future of our health services. We are a very special sort of community. First, we have very special population characteristics which are, perhaps, unique in western Europe. Our population is dispersed throughout the country in a way which is different from most other European countries. Our economic circumstances are different and, unfortunately our GNP and our per capita income are below European level. We have different social traditions and a different outlook in many areas to other countries.
All these things seem to dictate that we must design, evolve and work towards a health service which will be suited to our own circumstances, conditions and needs and, above all, which we will be able to afford to pay for. I suggest that in the evolution of such a health service there are a number of guidelines we should follow. It must be recognised that the provision of a free health service generates a continually increasing demand for that service. Perhaps that is not something that was fully understood and realised a decade ago but it has now become increasingly obvious to everybody who studies the situation. If in the area of health a free service is provided the provision of that service generates a continually increasing demand for it. That is an important factor which must be kept in mind in any planning of the evolution and development of a health service.
A very important aspect of our thinking in this regard should be that an increasing emphasis must be placed on preventive medicine, on health education, on physical fitness and on the question of dealing with drugs, alcohol and tobacco. In all these areas if we place an increasing emphasis immediately it will ultimately go to help in dealing with the financial implications of the entire health service. Money spent in these areas of preventive medicine will ultimately bring down the overall cost of health to the community. In that connection it is important to realise what happened in Britain in regard to the health service there. The idealists and the visionaries in the early days of that service sincerely believed that if a comprehensive national health service was brought in ultimately the very operation of that health service would be such that it would be possible to eliminate, to a great extent, illness and disease in the community and, eventually, the wholecost of health would come down. Of course, that has turned out to be a tragic illusion. In fact, the inevitable law I mentioned earlier is the one which is manifesting itself instead, namely, the very provision of a free health service generates an almost insatiable demand for that service as time goes on.
There must be a major shift from hospital to community medicine. We must try to get more medical attention provided in the local communities. That leads on to another principle to which we should subscribe, the need to build up the general medical service. I cannot understand the Minister's approach in this regard. His mind seems to be fastened on this business of free hospital services for all and he has set his mind against the progressive extension of the general medical service. That is a fundamental disagreement between the Minister and this side of the House. We believe that it is in the general medical service that extension should come. That is related to the principle of trying to have more medical and health care provided in the community as distinct from the hospital. There is no doubt that that would in time result in a lesser burden on the community in regard to the finance that has to be provided for health services.
Another aspect of this is of course the principle which I believe we must adhere to, that is, that there is a very considerable reservoir of resources available in the private sector and in voluntary organisations which must be fully availed of and not ignored and discouraged as at present. In that connection I want just to mention an instance which I raised here a couple of times at Question Time with the Minister of the Ballindine Rehabilitation Centre provided by the Disabled Drivers' Association. There is a case where a voluntary orginisation by their own efforts have done a magnificent job in providing a centre for rehabilitation and training of their members. They have been tremendously successful in raising money and in getting on with the provision of this centre. The Minister has set his face against their efforts. He refuses to entertain any question of giving them a grant and in fact one detects a general air of hostility on the Minister's part towards that activity. This is something I cannot understand.
Our resources are scarce enough between what the general body of taxpayers can provide through the State and what can come from private sources and voluntary organisations. If we are ever to get anywhere near a reasonable level of a satisfactory comprehensive health service for all the people we will have to use every possible resource. We should not let ourselves have any blind spots about a particular area and if a voluntary organisation can do a job, encourage them to do it as in the case of the Disabled Drivers' Association.
Alternatively, if in the private hospitals and nursing homes there are facilities and services available why not avail of them, why try to discourage these people from providing the services? Certainly, I want to say that in our case on this side of the House, when it is our responsibility to propound a comprehensive health service we will certainly have as a central principle the full utilisation of all the resources which can be provided in the private sector and by voluntary organisations.
Also, I believe that the principle of insurance must be availed of to the greatest possible extent. It is becoming increasingly clear in modern communities that it is only through voluntary personal insurance that a really satisfactory standard of health can be provided for a large section of the community. The value of voluntary health insurance in this country has been proved beyond any doubt. The Voluntary Health Insurance Board is the most successful State organisation ever established in this country. It has proved that this is a way in which a satisfactory level of health services can be provided for a particular section of the community and I believe that part of the answer to a satisfactory health service for the future lies in that direction, bringing more and more people into the framework of voluntary health insurance.
As I said, these are some indications of the way in which I believe we should proceed. I believe that there is a very real danger at this stage that an appropriate level of services is not going to be provided in the community where they are needed because of a shortcoming in the financial provisions made by the Minister and the Government for health this year, and I believe the first thing to do is for the Minister to persuade the Government to make available the additional moneys which are needed to enable our services to be maintained at a satisfactory level in 1976. That is the first thing which I want to impress upon the Minister.
The second thing I want to say is that this situation in health which has arisen because of the budgetary crisis which the Minister for Finance has brought upon all of us, should be used to focus our attention on the need to plan our health services for the future, plan for their development and plan for their financing and I believe that that planning is needed now. There is still time to do it. There is still time to develop a programme of development for health services which would be sensible and rational, which would be suitable to our needs and which would be within our capacity to pay for, particularly if built up upon the lines I have very briefly suggested. We still have time to do that. I believe we should do it very soon. I do not believe an inter-departmental committee of officials of the Department of Health and the Department of Social Welfare is the way to do it. There are other vehicles and approaches to do that job. I do not expect that this Government or this Minister is going to do it but I can assure the Minister that when it is our turn we will tackle this thing in a sensible, rational, progressive-minded fashion.